Despite proven cardiovascular benefits, GLP-1 receptor agonists were prescribed to only 4-5% of UK type 2 diabetes patients by end of 2019, with even lower use in patients who already had heart disease.
Only 4.3% prescribed GLP-1Among UK diabetes patients with existing heart disease — those who would benefit most — GLP-1 receptor agonist use was just 4.3% by end of 2019
What the researchers found
GLP-1RA use was only 4.3-4.9% and SGLT2i use 9.8-13.8% in UK T2DM patients by December 2019, with paradoxically lower use in patients with CVD history who would benefit most. Insulin use was 16% in CVD patients despite no cardiovascular evidence.
Why it matters
Heart disease is the leading killer of diabetes patients. Drugs proven to prevent cardiovascular events are being dramatically underused in the patients who need them most, while drugs without heart benefits are widely prescribed.
The numbers in context
31% with CVD; SGLT2i: 9.8% (CVD) vs 13.8% (no CVD); GLP-1RA: 4.3% vs 4.9%; insulin: 16% vs 9.7%; SGLT2i as triple therapy rose from 22.7% to 41.3% (CVD) 2017-2019
How the study worked
Descriptive cross-sectional analysis using UK Clinical Practice Research Datalink (CPRD). Four time points (2017-2019). 143,373-166,012 patients per cross-section. Age-standardized prescribing proportions by CVD history, treatment line, and UK country.
Who was studied
UK adults with type 2 diabetes in the Clinical Practice Research Datalink (CPRD)
What this study cannot tell us
UK-specific data that may not generalize to other healthcare systems. Cross-sectional design cannot determine reasons for prescribing decisions. Data ends at 2019 — GLP-1 prescribing has increased substantially since. Does not capture patient preferences or contraindications.
How to read the evidence
Moderate evidence: large population-based study using validated primary care database, but descriptive design cannot explain causal factors behind prescribing patterns.
When this study was published
Published 2021 with data through 2019. GLP-1 prescribing has increased significantly since, driven by weight management indications and growing cardiovascular evidence.
The bigger picture
This prescribing gap reflects a global pattern where evidence-based advances in peptide therapeutics are slow to reach patients. As GLP-1 drugs gain broader recognition (partly through weight loss applications), their cardiovascular benefits in diabetes may finally drive appropriate prescribing.
Questions still open
- Has GLP-1RA prescribing increased substantially since 2019 as awareness of cardiovascular benefits grew?
- What barriers prevent physicians from prescribing GLP-1 drugs to high-risk cardiovascular patients?
- Would automatic clinical decision support alerts increase appropriate GLP-1RA prescribing in CVD patients?
Common questions
Why aren't more diabetes patients prescribed GLP-1 drugs if they protect the heart?
Has GLP-1 prescribing improved since this study?
Read the original research
Prescribing in Type 2 Diabetes Patients With and Without Cardiovascular Disease History: A Descriptive Analysis in the UK CPRD.
Clinical therapeutics, 43(2), 320-335
Citation
Farmer, Ruth E; Beard, Ivan; Raza, Syed I; Gollop, Nicholas D; Patel, Niraj; Tebboth, Abigail; McGovern, Andrew P; Kanumilli, Naresh; Ternouth, Andrew. (2021). Prescribing in Type 2 Diabetes Patients With and Without Cardiovascular Disease History: A Descriptive Analysis in the UK CPRD.. Clinical therapeutics, 43(2), 320-335. https://doi.org/10.1016/j.clinthera.2020.12.015