GLP-1 receptor agonist use in Australia grew 11-fold from 2014 to 2022, with prescribing expanding beyond diabetes into cardiology as cardiovascular benefit evidence accumulated.
11-fold growthGLP-1 receptor agonist use in Australia grew 11-fold in 8 years as cardiovascular benefit evidence expanded indications beyond diabetes
What the researchers found
GLP-1 receptor agonist use in Australia grew 11-fold between 2014 and 2022, reaching approximately 120,000 users by July 2022. SGLT2 inhibitor growth was even more dramatic at 216-fold, reaching 250,000 users.
Critically, from 2022 onwards, about 1 in 5 new SGLT2i users didn't have type 2 diabetes — indicating expanding use for cardiovascular indications alone. Cardiologist-initiated prescriptions reached 10% of new SGLT2i starts by mid-2022. Among GLP-1 RA users with cardiovascular conditions, dulaglutide and semaglutide were the most commonly prescribed. Most new users of both drug classes had evidence of both diabetes and cardiovascular disease.
Why it matters
This study captures the real-time adoption of GLP-1 drugs as they transitioned from diabetes medications to cardiovascular drugs. The 11-fold growth in GLP-1 RA use and the emergence of non-diabetic prescribing reflect how cardiovascular outcome trial results (like SUSTAIN-6 and SELECT) transformed clinical practice. Australia's data shows a global trend: as evidence for peptide-based drugs' heart benefits accumulates, their prescribing base is expanding far beyond endocrinology into cardiology.
The numbers in context
216-fold SGLT2i growth · 11-fold GLP-1 RA growth · ~250,000 SGLT2i users by July 2022 · ~120,000 GLP-1 RA users · 1 in 5 new SGLT2i users without T2D · 10% cardiologist initiation · 2014–2022 period
How the study worked
Population-based study using national dispensing claims from a 10% random sample of Australians (January 2014 to July 2022). Researchers counted monthly prevalent and new users, assessed prescriber specialty, and used prior antidiabetic and cardiovascular medication use as proxies for diabetes and cardiovascular conditions.
Who was studied
10% random sample of Australians dispensed SGLT2 inhibitors or GLP-1 receptor agonists, 2014–2022
What this study cannot tell us
Australian data may not generalize to other healthcare systems with different drug access and reimbursement policies. Dispensing claims are a proxy — they show medications filled, not necessarily taken. Using prior medication claims as proxies for diabetes and cardiovascular disease may misclassify some patients. The 10% random sample may introduce sampling variability. Data ends July 2022, before the most dramatic semaglutide prescribing surge.
How to read the evidence
Moderate — well-designed population-based study using comprehensive national dispensing data. The sample is representative and the methodology is standard for pharmacoepidemiology. The descriptive nature (trends, not outcomes) limits the depth of conclusions, but the data clearly captures prescribing patterns.
When this study was published
Published in 2023 using data through July 2022. GLP-1 RA prescribing has likely accelerated further since, particularly after semaglutide's obesity indication and the SELECT cardiovascular outcomes trial results.
The bigger picture
This study captures a historic transition in medicine: peptide drugs moving from a single indication (blood sugar control) to a broader role in cardiovascular protection. The pattern seen in Australia is repeating globally as semaglutide's weight loss indication and cardiac benefit data drive prescribing even further. The involvement of cardiologists — traditionally unfamiliar with peptide-based drugs — represents a cultural shift in prescribing patterns that will only accelerate with newer multi-agonists like tirzepatide and retatrutide.
Questions still open
- How much further has GLP-1 RA use grown since July 2022, given the semaglutide obesity indication approval?
- Are the cardiovascular benefits of GLP-1 RAs being realized in Australian real-world data, or only in clinical trials?
- Will expanding GLP-1 RA use beyond diabetes into cardiology create sustainability challenges for Australia's pharmaceutical benefits scheme?
Common questions
Why are GLP-1 drugs now being prescribed for heart disease, not just diabetes?
Is Australia representative of global GLP-1 prescribing trends?
Read the original research
Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014-2022).
European journal of clinical pharmacology, 79(9), 1239-1248
Citation
Lin, Jialing; Pearson, Sallie-Anne; Greenfield, Jerry R; Park, Kyeong Hye; Havard, Alys; Brieger, David; Day, Richard O; Falster, Michael O; de Oliveira Costa, Juliana. (2023). Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014-2022).. European journal of clinical pharmacology, 79(9), 1239-1248. https://doi.org/10.1007/s00228-023-03539-8