Changes over time in the cardiovascular risk profile of type 2 diabetes from 2007 to 2020: A community‐based study

Abstract Aims To quantify changes over time in cardiovascular (CV) risk factor control and in the uptake of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter‐2 (SGLT2) inhibitors from 2007 to 2020 in a real‐world community‐based cohort of type 2 diabetes (T2D) patients. Materials and Methods This study identified 95 461 T2D patients, who were followed for an average of 6.4 years through a single healthcare organization's electronic health record. The primary outcome was global risk factor control according to four factors (“ABCS”): glycated haemoglobin (Hb A 1c [<8%]); B lood pressure (systolic/diastolic <140/90 mmHg); C holesterol (non‐HDL cholesterol <130 mg/dL); and S moking (not). Concomitant presence of microvascular complications and commonly used medication classes were tracked. Results According to the ABCS metric, global risk factor control did not appreciably change over time; in 2020, 40.9% (95% confidence interval 40.2, 41.5) of patients had all four factors controlled. Among individual components, HbA1c control (<8%) worsened over time from 84% in 2007 to 78% in 2020, while lipid control (non‐HDL cholesterol <130 mg/dL) improved from 59% to 72%. Coexisting microvascular complications were more prevalent over time; for example, neuropathy prevalence increased from 21% (2007) to 35% (2020). Use of thiazolidinediones and sulphonylureas decreased over time while metformin, insulin, dipeptidyl peptidase‐4 inhibitor, GLP‐1RA and SGLT2 inhibitor use increased. In 2020, GLP‐1RAs and SGLT2 inhibitors were each used by 13% of T2D patients. Conclusions In this community‐based study, global CV risk factor control in T2D did not improve, although glycaemic control worsened and lipid control improved. Given increased uptake of GLP‐1RAs and SGLT2 inhibitors, the collective effect of these changes on CV outcomes warrants evaluation.