Expert Q&A

Will New ADA Guidelines Impact GLP-1 RA, SGLT-2 Inhibitor Usage?

In a recent study, Shichao Tang, PhD, and colleagues found that although more than 80% of patients with type 2 diabetes meet the recommended criteria for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter-2 (SGLT-2) inhibitors use, only 3.7% used GLP-1 RAs, 5.3% used SGLT2 inhibitors, and 9.1% used either medication.1

To discuss why these percentages are so low and whether new guidelines will have an impact on these numbers and/or clinical practice, Consultant360 spoke with the lead author of the study, Dr Tang, economist in the Division of Diabetes Translation for the CDC.

Consultant360: What was the impetus for this research? Why now?

Shichao Tang, PhD: These medications were recommended in 2022 as first-line therapy for people with type 2 diabetes who have (or are at high risk for) certain complications. We wanted to estimate the number of people who are eligible to use these medications, as well as the percentage of people who meet the recommended criteria and were already using them. It’s critical that we continue to study the best ways to manage type 2 diabetes, but it’s also important to examine how available these methods are to people. This includes researching how many people are using certain tools or medications and how many people are eligible for them, which was the aim of this study. This can help inform other surveillance or research that is needed.

C360: How do the new American Diabetes Association guidelines2 impact these results? Your study took place while GLP-1 RAs and SGLT-2 inhibitors were considered second-line therapies. But now that they can be used as first-line treatment options, do you expect these usage percentages to increase in follow-up studies? Or is cost that big of a barrier?

Dr Tang: This study cannot estimate or predict the impact of these medicationsincluding the number of people who will use themnow that the guidelines recommend these medications as first-line therapy for certain patients. It’s important to continue research since the change in recommendations. 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.

C360: In your view, are we in the era of “precision pharmacology for diabetes3 where we will see more doctors consider risk for heart or kidney disease, weight, or blood sugar levels when deciding which drug to prescribe?

Dr Tang: 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. It’s critical that health care providers work closely with their patients to help them effectively manage type 2 diabetes and prevent complications. This can include prescribing medications and encouraging lifestyle changes. Indeed, both GLP-1 RAs and SGLT-2 inhibitors may yield additional clinical benefits in some populations—like patients with comorbidities such as cardiovascular disease and chronic kidney disease.

C60: How does this study impact other specialists? Which ones and why?

Dr Tang: It’s important to note that a major aspect of the study was to determine how many people with type 2 diabetes are eligible for these drugs, and we found that most people with type 2 diabetes meet the new criteria for these medications. It’s important for health care providers, including specialists who treat diabetes or complications related to diabetes, to be aware that many of their patients with type 2 diabetes may now qualify for these medications. 

Want to learn more about this research? Check out our research summary on the full study, and for all of Consultant360's research summaries, click here.


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.     ElSayed NA, Aleppo G, Aroda VR. Standards of care in diabetes—2023. Diabetes Care. 2022;46:S1-S4. doi:10.2337/dc23-Sint.

3.     Perez-Castells A. New diabetes drugs like Ozempic are changing how patients are treated. Wall St. Journal. Published March 5, 2023. Accessed March 13, 2023.