SAT-611 - Underutilization of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors Among U.S. Adults with Type 2 Diabetes Mellitus: Differences by Metabolic Syndrome Status

Introduction: Metabolic syndrome (MetS) comprises various cardiovascular (CV) risk factors driven by insulin resistance and chronic inflammation and is highly prevalent among adults with type 2 diabetes (T2DM), substantially increasing CV risk. Use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) has shown robust cardiometabolic benefits and are particularly relevant for patients with MetS. We examined whether the utilization of these therapies varies with MetS burden among United States adults with T2DM.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2015 through March 2020 (pre-pandemic). Adults aged ≥18 years with T2DM were included. T2DM was defined by self-reported physician diagnosis, hemoglobin A1c ≥6.5%, fasting glucose ≥126 mg/dL, or glucose-lowering medication use. MetS was defined according to Adult Treatment Panel III criteria (≥3 components). MetS severity was categorized as 0-2 components (reference group), 3 components, and 4-5 components. Use of GLP-1 RA, SGLT2i, and a composite of either agent was identified. Survey-weighted logistic regression was used to estimate unadjusted odds ratios, and survey-weighted Poisson regression with robust variance was used to estimate adjusted prevalence ratios (aPRs), adjusting for age, sex, and race/ethnicity. Adjusted prevalence estimates were derived from marginal predictions.

Results: The weighted study population represented 38.3 million U.S. adults with T2DM, of whom 47.4% were female, with a mean age of 58.5±14.3 years. This population included 8.24 million without MetS and 30.1 million with MetS. By MetS status and medication use, 254,110 adults without MetS and 2.29 million adults with MetS reported use of a GLP-1 RA or SGLT2i. In survey-weighted analyses, prevalence of use was 3.1% (95% CI 1.4-6.8) among adults without MetS and 7.6% (95% CI 5.3-10.7) among those with MetS (unadjusted OR 2.59, 95% CI 1.15-5.82; p=0.023). After adjustment, MetS remained independently associated with higher use (aPR 2.39, 95% CI 1.07-5.34; p=0.034).

By MetS severity, adjusted prevalence increased from 3.17% (95% CI 0.48-5.87) in adults with 0-2 components to 8.29% (95% CI 3.05-13.52) in those with 3 components (p=0.048), and 7.00% (95% CI 3.90-10.10) in those with 4-5 components (p=0.073). Class-specific use remained low: GLP-1 RA use was 1.53% (95% CI 0.39-5.89) without MetS and 4.70% (95% CI 3.31-6.64) with MetS, while SGLT2i use was 2.56% (95% CI 0.99-6.47) without MetS and 3.56% (95% CI 1.92-6.48) with MetS.

Conclusion: Although there is a significant increase in the use of SGLT2i and GLP-1 RA in patients with MetS and T2DM, the absolute utilization of these therapies remains low at under 10%. This highlights the importance of implementing strategies to improve management of the residual risk in this patient population.

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