GLP-1 Drug Use Remains Low in UK Diabetes Patients Despite Heart Protection Evidence
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Only 4.3% prescribed GLP-1 Among 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
- Evidence Grade:
- Moderate evidence: large population-based study using validated primary care database, but descriptive design cannot explain causal factors behind prescribing patterns.
- Study Age:
- Published 2021 with data through 2019. GLP-1 prescribing has increased significantly since, driven by weight management indications and growing cardiovascular evidence.
- Original Title:
- Prescribing in Type 2 Diabetes Patients With and Without Cardiovascular Disease History: A Descriptive Analysis in the UK CPRD.
- Published In:
- Clinical therapeutics, 43(2), 320-335 (2021)
- Authors:
- Farmer, Ruth E, Beard, Ivan, Raza, Syed I, Gollop, Nicholas D, Patel, Niraj, Tebboth, Abigail, McGovern, Andrew P, Kanumilli, Naresh, Ternouth, Andrew
- Database ID:
- RPEP-05372
Evidence Hierarchy
Frequently Asked Questions
Why aren't more diabetes patients prescribed GLP-1 drugs if they protect the heart?
Possible reasons include cost, injection requirement (most GLP-1 drugs are injected), physician familiarity, clinical inertia, and prescribing guidelines that may not yet have fully incorporated cardiovascular evidence. The study highlights a significant evidence-practice gap.
Has GLP-1 prescribing improved since this study?
Almost certainly yes. Since 2019, GLP-1 drugs like semaglutide have gained enormous public attention for weight management. Growing awareness of both weight loss and cardiovascular benefits has likely increased prescribing, though data on whether the CVD-specific gap has closed is still emerging.
Read More on RethinkPeptides
Cite This Study
https://rethinkpeptides.com/research/RPEP-05372APA
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
MLA
Farmer, Ruth E, et al. "Prescribing in Type 2 Diabetes Patients With and Without Cardiovascular Disease History: A Descriptive Analysis in the UK CPRD.." Clinical therapeutics, 2021. https://doi.org/10.1016/j.clinthera.2020.12.015
RethinkPeptides
RethinkPeptides Research Database. "Prescribing in Type 2 Diabetes Patients With and Without Car..." RPEP-05372. Retrieved from https://rethinkpeptides.com/research/farmer-2021-prescribing-in-type-2
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.