A large retrospective study published in the American Journal of Preventive Cardiology found that most adults with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD) are not receiving two drug classes with proven heart-protective benefits. Analyzing electronic medical records from over 8,000 patients at Houston Methodist, researchers found that only 22% were prescribed an SGLT2 inhibitor and 25.3% a GLP-1 receptor agonist — despite both being guideline-recommended for this high-risk population.

The study also uncovered notable sex-based prescribing disparities. Women were significantly less likely to receive SGLT2 inhibitors for cardiovascular protection, while being more likely to receive GLP-1s — suggesting clinicians may be prescribing by patient phenotype (e.g., obesity vs. heart failure) rather than by overall cardiovascular risk. Experts warn this reflects a concerning pattern in clinical decision-making that needs to be addressed.

By the Numbers:

• 8,096 adults with type 2 diabetes and ASCVD studied (mean age 69.4 years; 38.8% women)
• 22% prescribed an SGLT2 inhibitor; 25.3% prescribed a GLP-1
• 85.6% prescribed a statin; 78.1% on any glucose-lowering medication
• Women were 20% less likely to receive an SGLT2 (aOR = 0.8) but 18% more likely to receive a GLP-1 (aOR = 1.18)

Why it matters: These medications can meaningfully reduce cardiovascular events and kidney disease progression, yet most eligible patients aren't getting them. Closing this prescribing gap — through better clinician awareness, reduced cost barriers, and greater pharmacist involvement — could prevent significant morbidity and mortality in a very high-risk population.