(126) Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogues (GLP-1a) for cardiovascular risk in Australia (2014-2022)

Publication Number: 787

Background: SGLT2i and GLP-1a medicines, initially developed for treating type 2 diabetes (T2D), have also been demonstrated to reduce cardiovascular endpoints. This evidence led to the expansion of therapeutic indications for several SGLT2i on Australia’s national formulary – the Pharmaceutical Benefits Scheme. However, there is limited evidence on patterns of SGLT2i and GLP-1a use in Australia after the publication of evidence of cardiovascular benefits (since 2015) and the expansion of therapeutic indications (2022).

Objectives: To investigate trends in SGLT2i and GLP-1a use over time in Australia in the era of increased evidence of their cardiovascular benefits.

Methods: We used national dispensing claims for a 10% random sample of Australians to estimate the number of prevalent and new users (no dispensing in the prior year) of SGLT2i and GLP-1a per month from January 2014 to July 2022. We assessed prescriber specialty (endocrinologist, cardiologist, nephrologist and other clinicians) and prior use of other antidiabetic and cardiovascular medicines as a proxy for T2D and cardiovascular conditions, respectively.

Results: We found a large increase in the number of prevalent users (216-fold for SGLT2i; 11-fold for GLP-1a); in July 2022 approximately 250,000 Australians were dispensed SGLT2i and 120,000 GLP-1a. Most new users of SGLT2i or GLP-1a had evidence of both T2D and cardiovascular conditions, although from 2022 onwards, approximately one in five new users of SGLT2i did not have evidence of T2D. The proportion of new users initiating SGLT2i by cardiologists increased after 2021, reaching 10.0% of initiations in July 2022. Among new users with evidence of cardiovascular conditions, empagliflozin was the most commonly prescribed SGLT2i, while dulaglutide or semaglutide was the most common GLP-1a.


Conclusions: SGLT2i and GLP-1a use is increasing in Australia, particularly in populations with higher cardiovascular risk. The increased use of SGLT2i among people without evidence of T2D suggests that best-evidence medicines are adopted in Australia across specialties, aligning with new evidence and expanding indications.