(B-114) Temporal Trends in Clinical Characteristics and Treatment Patterns of Patients with Both CKD and T2D Initiating a GLP-1 RA and SGLT2i: Findings From a Large Database in the United States, 2014-2023

Background: Patients with type 2 diabetes (T2D) are at high risk for chronic kidney disease (CKD). Recently, sodium-glucose cotransporter-2 inhibitor (SGLT2i) medications were approved for CKD treatment, and trials suggest beneficial renal effects for glucagon-like peptide-1 receptor agonists (GLP-1 RA). The dynamic clinical landscape of treatment options for patients with T2D and CKD calls for an examination of the evolution of treatment patterns for these T2D medications.

Objectives: To describe temporal changes in clinical characteristics and treatment patterns among patients with T2D and CKD who initiated a GLP-1 RA or SGLT2i from 2014-2023 in the United States.

Methods: Patients diagnosed with CKD and T2D who initiated a GLP-1 RA or SGLT2i were identified in Optum’s deidentified Clinformatics® Data Mart Database in 2 time periods: period 1 (P1), January 2014-June 2021, before widespread introduction of new CKD medications and treatment guidelines; and period 2 (P2), July 2021-September 2023, largely after. Clinical and treatment characteristics (measured before or on medication initiation date) for each of the GLP-1 RA and SGLT2i cohorts were described and compared between the 2 time periods with standardized mean differences (SMD). This study was part of the FOUNTAIN real-world evidence generation platform.

Results: There were 56,219 SGLT2i initiators in P1 and 94,080 in P2; 70,158 GLP-1 RA initiators were identified in P1 and 72,816 in P2. Initiators of both therapies were older on average in P2 than P1 (SGLT2i: 73 vs 69 years; GLP-1 RA: 70 vs 68 years). Compared to P1, SGLT2i initiators in P2 were less likely to have used another T2D therapy in the 6 months prior (16% vs 29%; SMD 0.3), whereas a greater proportion of GLP-1 RA initiators in P2 had used an SGLT2i in the prior 3 months (23% vs 13%; SMD 0.3). More patients initiating a GLP-1 RA in P2 compared with P1 had hemoglobin A1c levels ≤7% (17% vs 10%; SMD 0.2); fewer SGLT2i initiators in P2 had A1c >9% compared with P1 (9% vs 17%; SMD 0.2). In both medication cohorts, initiators in P2 were more likely to have severe (stage 3) CKD (SGLT2i: 52% vs 26%, SMD 0.5; GLP-1 RA: 44% vs 28%, SMD 0.3). SGLT2i initiators in P2 vs P1 were more likely to have a diagnosis (36% vs 22%; SMD 0.3) and hospitalization (6% vs 2%; SMD 0.2) for congestive heart failure (CHF).

Conclusions: In the period since new therapeutic options and guidelines for patients with CKD and T2D, there was a shift in initiation patterns towards older patients with better T2D control, less intense T2D medication regimens, more severe CKD at medication initiation and, for SGLT2is, increased CHF burden. This may be due to changes in guidelines leading to better T2D control and new indications for SGLT2i, making it a preferred therapy for these patients, including those with cardiovascular disease.