Newer, more effective diabetes drugs reach only a fraction of patients

A UCSF analysis has found that the newer generation of much more effective diabetes medications are reaching only a fraction of the patients who are recommended to take them based on new guidelines.

Type 2 diabetes (T2D), a condition in which the body can't use insulin to clear sugar from the bloodstream, affects 1 in 10 Americans. It comes with grave health risks, including cardiovascular and kidney disease.

The study assessed medications that patients received within a year of T2D diagnosis. During the period under review - 2014 to 2022 - groups like the American Diabetes Association and the American Heart Association began encouraging the use of newer medications over some older, less effective ones.

The analysis, which is based on more than 40,000 records from the University of California Health Data Warehouse, found some encouraging results. 

The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 (GLP-1) receptor agonists - two newer categories of drugs - increased, particularly among patients with cardiovascular or kidney disease.

Meanwhile, the use of sulfonylureas - a category of diabetes drug with severe side effects, now seen as a last resort in treatment - declined. And the use of metformin and insulins, the classic medications for diabetes, declined slightly. 

Still, by 2022, just 20% T2D patients were receiving GLP-1 drugs within a year of diagnosis, and less than 15% of patients were receiving SGLT2 drugs - reflecting a gap between what the professional guidelines recommend and the care that patients are receiving.

The researchers gave several reasons for why this might be. One is that GLP-1 drugs, like Wegovy and Ozempic, are expensive, and insurance doesn't always cover them. Another is that not every provider knows that leading organizations recommend prescribing GLP-1 and SGLT2 drugs, like Jardiance or Farxiga, for T2D from the moment of diagnosis. 

Some of the most devastating consequences of diabetes come from its effects on the heart and kidney, and thankfully, we now have drugs that target those effects head on. But to maximize the benefit for the many hundreds of thousands of patients in the U.S., we need to increase access to these drugs and make sure that clinicians understand just how beneficial they are." 

Jonathan Watanabe, PharmD, MS, PhD, the senior author of the study