Adv Ther. 2026 Jul 9. doi: 10.1007/s12325-026-03699-w. Online ahead of print.
ABSTRACT
INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) exert complementary metabolic effects and have independently demonstrated cardiovascular benefits in individuals with type 2 diabetes mellitus (T2DM) and established atherosclerotic cardiovascular disease (ASCVD). However, despite growing evidence suggesting potential additive benefits in high-risk populations, real-world data on dual therapy remain limited. This study aimed to identify clinical factors associated with the use of combined GLP-1RA/SGLT2i therapy in routine practice.
METHODS: This retrospective observational study included 202 adults with T2DM and established ASCVD admitted to a tertiary care hospital between November and December 2025. Patients were categorized according to their pre-admission outpatient regimen into four groups: neither therapy, GLP-1RA only, SGLT2i only, and combined therapy. Clinical characteristics and comorbidities were recorded at admission. Multinomial logistic regression analysis was performed to identify factors associated with treatment allocation.
RESULTS: Among 202 patients, 54.5% were not receiving either class, 10.9% were treated with GLP-1RA only, 21.3% with SGLT2i only, and 13.4% with both. In adjusted analyses, combined therapy was independently associated with younger age [odds ratio (OR) 0.89 per year, 95% confidence interval (CI) 0.84-0.95, p < 0.001], presence of heart failure (OR 9.64, 95% CI 2.65-35.04, p < 0.001), and insulin use (OR 10.99, 95% CI 3.12-38.72, p < 0.001). Chronic kidney disease and polyvascular disease were not associated with dual therapy use.
CONCLUSION: In this real-world cohort of patients with T2DM and ASCVD, more than half were not receiving a cardioprotective glucose-lowering therapy. Combined GLP-1RA/SGLT2i therapy was infrequently prescribed and was associated with selected clinical characteristics rather than overall cardiorenal risk burden. These findings highlight an opportunity to better align treatment strategies with a comprehensive risk-based approach.
PMID:42423950 | DOI:10.1007/s12325-026-03699-w