Trends in use of cardiorenal protective medication among people with type 2 diabetes and chronic kidney disease in Denmark

Objective: Kidney- and cardiovascular complications are the main challenges in modern diabetes care. Several drugs to prevent these have emerged in recent years. A key problem is therapy implementation to ensure benefits demonstrated in trials and recommended in guidelines. We investigated time-trends in use of cardiorenal protective medication in persons with type-2 diabetes(T2D) with or without chronic kidney disease (CKD). Research design and Methods: By use of data from Danish health registers we were able to identify individuals with diabetes and stratify them by CKD status. We assessed the medication use in individuals with T2D with and without CKD on a national level between 2011-2022. Results: By 2022, 312,990 persons had T2D and 102,216 (33 %) of these had CKD. Use of SGLT2i and GLP-1RA increased over time and was more abundant among persons with T2D without CKD, whereas the use of ACE-inhibitors, ARBs, MRA, antiplatelet - and lipid lowering drugs was more frequent among people with diabetes and CKD. The use of cardiorenal protective medication across age and sex was similar for persons with T2D with or without CKD with men having marginally higher degree of exposure than women for most medication classes except GLP-1RA and ARB. Conclusion: Exposure to SGLT2i and GLP-1RA increased over time but was, in contrast to current guideline recommendations, more pronounced among individuals with diabetes without CKD and contrary to the other cardiorenal protective medications. The cardiorenal protective benefits of these agents can only be achieved with continued focus on implementation of guideline recommendations for high-risk individuals with complications.