Implementation of guideline-directed cardioprotective therapy in patients living with type 2 diabetes in outpatient cardiology ambulatory setting: the Italian CardioMET registry

Background: To assess the implementation of guideline-directed glucose-lowering therapies with proven cardiovascular (CV) benefit in individuals with type 2 diabetes mellitus (T2DM) attending Italian outpatient cardiology clinics. Methods: CardioMET is a multicenter, real-world registry including 2527 consecutive patients with T2DM enrolled between January 2022 and December 2025. Clinical characteristics, CV risk profile, and prescription rates of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) were assessed. Multivariable logistic regression was performed to identify predictors of non-prescription. Results: Overall, 70.7% of patients had established atherosclerotic CV disease (ASCVD), while 86.1% of those without ASCVD were classified at high or very high CV risk. Heart failure (HF) was present in 48.9% of patients with available data. SGLT2i were prescribed in 42.2% and GLP-1 RA in 27.7% of patients, whereas 14.8% received combination therapy. SGLT2i use was higher in patients with ASCVD than in high/very high CV risk no ASCVD patients (45.0%vs. 34.9%; p < 0.001) and in patients with HF, whereas no differences between groups in prescription rates of GLP-1 RA were observed. Prescription of both drug classes significantly increased after publication of 2023 ESC Guidelines (SGLT2i: 54.7% vs. 35.0%; GLP-1 RA: 48.4% vs. 15.8%; both p < 0.001). Older age, female sex (for SGLT2i), and absence of established ASCVD independently predicted non-prescription. Conclusions: Implementation of cardioprotective glucose-lowering therapies remains suboptimal in Italian outpatient cardiology practice, underscoring the need for a multidisciplinary approach integrating recommendations from CV, T2DM, and kidney guidelines to optimize implementation of therapy in patients with T2DM.