Research Summary

Most Adults With Diabetes Can Use GLP-1 RAs, SGLT-2 Inhibitors But Don't

Anthony Calabro, MA

In a recent national population-based study,1 researchers estimated that, on an annual basis, 82.3% of US adults with type 2 diabetes (n = 22.4 million) and most Medicare beneficiaries would meet the recommended criteria for using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. And yet, from 2017 to 2020, for those who met the criteria, only 3.7% used GLP-1 RAs, 5.3% used SGLT2 inhibitors, and 9.1% used either medication.

Interestingly, this study took place while GLP-1 RAs and SGLT-2 inhibitors were still considered second-line therapies. In a 2022 Consensus Report2, the American Diabetes Association and European Association for the Study of Diabetes recommended these medications as a first-line therapy for people with type 2 diabetes who have or are at high risk for certain complications such as heart failure, chronic kidney disease, and atherosclerotic cardiovascular disease (ASCVD).

More research is needed before researchers can determine whether the new recommendations will have any impact on the usage numbers among the study population.

“While we can’t predict the impact that these drugs will have now that newer guidelines are in place, any advancement in treatments that can help reduce the burden of diabetes complications is positive news,” Shichao Tang, PhD, economist in the Division of Diabetes Translation for the CDC, told Consultant360.

In the current study, researchers included a cohort of 1330 adults 20 years of age or older who had type 2 diabetes and were enrolled in the National Health and Nutrition Examination Survey. The participants included those with heart failure, CKD, ASCVD (and those considered high risk for ASCVD), and excluded those with type 1 diabetes.

When compared with older treatments, GLP-1 RAs and SGLT-2 inhibitors have been shown3 to reduce body weight and decrease progression of CVD and CKD. These medications are far more expensive compared with other first-line therapies. Just how much the price tag of these medications impacts usage among the study population will require additional study.

This study had several limitations. For example, some of the health conditions were self-reported, which could lead to inaccurate data. Second, as mentioned, more recent guidelines have been published since the completion of their study, which may potentially increase the use of the medications among the study population.

“It’s important to continue research since the change in recommendations,” Dr Tang told Consultant360. “Newer data, when available, can help us observe if and how the new recommendations affect usage of these therapeutics. More research is also needed to understand any potential barriers to use, including cost.”

Want more insight on this research? Check out this Q&A with lead author, Shichao Tang, PhD.


1.     Tang S, Shao H, Ali MK, Zhang P. Recommended and prevalent use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in a national population-based sample. Ann Intern Med. Published online February 28, 2023. doi:10.7326/M22-3051.

2.     Davies MJAroda VRCollins BSet alManagement of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care2022;45:2753-2786. doi:10.2337/dci22-0034

3.     Wilcox T, De Block C, Schwartzbard AZ, Newman JD. Diabetic agents, from metformin to sglt2 inhibitors and glp1 receptor agonists: JACC focus seminar. J Am Coll Cardiol. 2020;76(14):1719-1722. doi:10.1016/j.jacc.2020.02.056.