SGLT2 inhibitors and GLP1 receptor antagonists effectively control blood sugar but are prohibitively expensive

SGLT2 and GLP1 have been found to reduce atherosclerotic cardiovascular disease (ASCVD), microvascular disease, and mortality in addition to improving glycated hemoglobin (HbA1c) and cardiovascular risk factors.

Researchers have found in a new study that use of SGLT2 inhibitors and GLP1 receptor agonists as first-line treatment for type-2 diabetes would improve outcomes, but their use is prohibitively expensive treatment option.

The study is published in Annals of Internal Medicine.

These medications have been recommended for second-line therapy in both American and European guidelines but may be a prohibitively expensive treatment option for some payers.

Researchers from the University of Chicago Department of Medicine created an individual patient-level model to simulate the lifetime incidence, prevalence, mortality, and costs associated with having type-2 diabetes. They created several treatment outcomes, including the first-line use of metformin and second-line use of SGLT2 or GLP1, the first-line use of SGLT2, and the first-line use of GLP1.

After conducting analyses, the authors found that first-line SGLT2 inhibitors and GLP1 receptor agonists had lower lifetime rates of congestive heart failure, ischemic heart disease, myocardial infarction, and stroke compared with metformin. However, they also found that the costs for SGLT2 inhibitors would need to be reduced by 70 percent and by 90 percent for oral GLP1 receptor agonists to be cost-effective compared to metformin.

According to the authors, their study results indicate the need to reduce SGLT2 inhibitor and GLP1 receptor agonist medication costs substantially for patients with type 2 patients to improve health outcomes and prevent exacerbating diabetes health disparities.

Reference:

Brown E, Heerspink HJL, Cuthbertson DJ, Wilding JPH. SGLT2 inhibitors and GLP-1 receptor agonists: established and emerging indications. Lancet. 2021 Jul 17;398(10296):262-276. doi: 10.1016/S0140-6736(21)00536-5. Epub 2021 Jun 30. PMID: 34216571.