Newer anti-hyperglycemic drugs like sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists offer the possibility of health improvements beyond glycemic management, including weight loss, renal protection, and mitigating risk of cardiovascular disease (CVD) or other major cardiovascular (CV) adverse events.

And while these medications are expensive, they might provide long-term economic benefits to patients and the health care system.

A panel of clinicians and patient advocates will discuss the role of SGLT2 inhibitors and GLP-1 receptor agonists in the session, Perspective Panel—Dropping Cost and Complications—CVD Risk and DM—SGLT2s and GLPs for CVD, on Sunday, June 22, from 8:00–9:30 a.m., in Room W184 A–D of the McCormick Place Convention Center. On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85^th Scientific Sessions, from June 25–August 25.

Celeste Thomas, MD, Associate Professor of Medicine at the University of Chicago, said these new drugs likely change the natural history of the disease, an effect that has yet to be fully understood.

“With the weight loss that can be induced with these medications, many of my patients report improved energy and increased mobility,” Dr. Thomas said, adding that these medications also reduce the risk of disability and premature death from diabetes.

She noted these effects have national implications, citing statistics from the Centers for Disease Control and Prevention (CDC) website that $1 of every $4 in U.S. health care costs is spent caring for people with diagnosed diabetes, and that 48%–64% of lifetime medical costs for a person with diabetes are for treating related complications, such as heart disease and stroke.

“Therefore, achieving glycemic targets and avoiding complications not only improves patient morbidity and mortality, but can also mitigate health care costs,” Dr. Thomas said.

Grace K. Kim, MD, Assistant Professor in the Pediatric Diabetes and Endocrinology Division at Baylor College of Medicine/Texas Children’s Hospital, will share the youth clinician’s perspective.

“Youth-onset type 2 diabetes is increasing in the United States and globally,” Dr. Kim said. “This is a concern, given that youth-onset type 2 diabetes is associated with earlier CV complications and comorbidities than adult-onset diabetes and youth-onset type 1 diabetes.”

She said it is exciting that there are new medications available for treating type 2 diabetes in pediatric populations.

“Although evidence for cardiovascular mortality improvements with these medications in the pediatric population are not yet available, we see promise,” Dr. Kim said. “These medications improve A1C levels, itself a significant outcome, and potentially weight loss.”

Although cost-benefit analyses currently favor first-line metformin, there is a shift toward using SGLT inhibitors and GLP-1 receptor agonists earlier with metformin. Guidelines from the American Diabetes Association^® (ADA) and the International Society for Pediatric and Adolescent Diabetes now recommend the early addition of SGLT2 inhibitors or GLP-1 receptor agonists in patients with unmanaged glycemia within the first couple of months of starting metformin.

Dr. Kim highlighted the importance of provider awareness of these guidelines, explaining that youth-onset type 2 diabetes requires a multimodal and likely multi-agent approach, given the early emergence and rapid accumulation of complications in this setting.

Esra Karslioglu-French, MD, Clinical Associate Professor of Medicine at the University of Pittsburgh Medical Center (UPMC), will explore how these drugs impact hospital inpatient care and treatment of complications, the largest components of diabetes-related medical expenditures.

“Health care systems are exploring strategies to match the right patients with the right medications to reduce CV complications and to do so in a cost-effective way,” Dr. Karslioglu-French said.

In the high-risk diabetes program at UPMC, once a high-risk patient is identified, UPMC communicates with primary care physicians (PCPs) through the electronic medical record (EMR) and facilitates the consideration and prescription of SGLT2 inhibitors and/or GLP-1 medications to mitigate CV risk.

“Assessments conducted by our health economics division show that, at the end of 12 months, this approach increased the prescription of these medications and reduced the total medical costs for the high-risk population,” Dr. Karslioglu-French explained.

Notably, the cost mitigation was driven primarily by the prevention of inpatient hospitalizations.

“We can leverage EMR in our health care systems to identify high-risk patients who can benefit from these medications and improve both patient outcomes and address the cost burden, using a risk-adapted, PCP-anchored treatment strategy,” she said.

Neal Clemens will share the patient perspective on these pharmacotherapy options. The discussion will also feature invited speaker Erin Callahan of the Diabetes Patient Advocacy Coalition.