Disparities in adoption of new diabetic therapies with cardiovascular benefits

• Published in: Diabetes research and clinical practice Vol. 196; p. 110233
• Main Authors: Vasti, Elena C., Basina, Marina, Calma, Jamie, Maron, David J., Rodriguez, Fatima, Sandhu, Alexander T.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2023
• Subjects: Cardiovascular disease; Cardiovascular Diseases - drug therapy; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; GLP1 agonists; Glucagon-Like Peptide-1 Receptor - therapeutic use; Health disparities; Heart Failure - drug therapy; Humans; Hypoglycemic Agents - therapeutic use; Retrospective Studies; SGLT2 inhibitors; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Cardiovascular disease; Diabetes; GLP1 agonists; Health disparities; SGLT2 inhibitors
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2022.110233

•Given the known cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i), we analyzed treatment rates of these medications across medical comorbidities and sociodemographic characteristics to understand provider prescribing pattern among patients with commercial insurance.•We identified pharmacy fills of either GLP1RA or SGLT2i within 180 days of an index clinic visit with primary care or endocrinology.•We found that patients with high-risk comorbidities, Black, Hispanic or Asian patients and those with low-income were less likely to be treated with GLP1RA/SGLT2i therapy. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) have cardiovascular benefit, but adoption into clinical practice has been lagging. We aim to evaluate use of SGLT2i and GLP1a across socioeconomic strata (SES), medical risk as well as provider type. Methods: We conducted a retrospective cohort study of the prescription of SGLT2i or GLP1a within 12 months of clinic visit between January 1, 2018 and January 1, 2019 using de-identified claims data. The primary outcome was the composite of a medication fill of either an SGLT2i and/or GLP1a within 180 days of the index visit. Results: Of the total cohort, 125,636 (15.8 %) received either a GLP-1a or SGLT2i.The odds of prescription of either medication was 0.64 [p = 0.006)] in patients with heart failure. Patients who identified as Black, Hispanic or Asian had lower odds of the primary outcome [Black: (AOR 0.81, p < 0.000); Hispanic: (AOR 0.87, p < 0.000); Asian: (AOR 0.83, p < 0.000). The odds was higher for those treated by an endocrinologist versus primary care clinician [AOR 2.12, p < 0.000)].Conclusions: Prescriptionof SGLT2i or GLP1a was lower among patients with cardiovascular co-morbidities and those who identified as Black, Hispanic or Asian. Further efforts to minimize these disparities should be pursued.