37-OR: Racial and Socioeconomic Disparities in the Use of Newer Classes of Diabetes Medications

Abstract

Among patients with type 2 diabetes (T2D), racial/ethnic minorities and those of lower socioeconomic status (SES) have a higher burden of coronary artery disease, chronic kidney disease, and hypoglycemia. Therefore, these groups may especially benefit from newer diabetes medication classes (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors), but high cost may limit access. We conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) randomized trial to assess the associations of race/ethnicity and SES with newer diabetes medication use. Look AHEAD compared an intensive lifestyle intervention to diabetes support and education among U.S. adults with obesity and T2D enrolled from 2001-2004. Medications, all prescribed outside of the study, were ascertained yearly. We used Cox proportional hazards models to estimate the association between self-reported race/ethnicity and SES factors and time to initiation of any newer diabetes medication through October 2019, adjusted for time-varying HbA1c, BMI, and number/type of diabetes medications; and baseline study arm, demographics, and comorbidities; fully-adjusted results are presented. Of 4,892 participants, 64%, 16%, 13%, and 8% were white, black, Hispanic, and other race/ethnicities, respectively. Over a median follow-up of 8.3 years, 44% initiated a newer diabetes medication. Black race was associated with significantly lower initiation of newer medications compared to whites (HR 0.81; 95% CI 0.80-0.94); there was no difference by other race/ethnic group. Yearly family income was inversely associated with the outcome: HR 0.69 (95% CI 0.55-0.87) comparing the lowest vs. the highest income group. Education, employment, and health insurance were not significantly associated with the outcome. These findings provide evidence of racial and SES disparities in use of newer diabetes medications, independent of glycemic control, that may impede access to these drugs for the individuals who need them most. Disclosure A. Elhussein: None. M. Bancks: None. W.C. Knowler: None. A.L. Peters: Advisory Panel; Self; Abbott, Bigfoot Biomedical, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medscape, Novo Nordisk Inc., Sanofi US. Consultant; Self; Livongo Health. Research Support; Self; Dexcom, Inc., vTv Therapeutics. Other Relationship; Self; Livongo Health, Mellitus Health, Omada Health, Stability Healthcare, Whole Biome Inc. E.M. Vaughan: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions. J. Clark: None. S.J. Pilla: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK057149)

<p>Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice</p>

“… 67 This is also supported by a recent secondary analyses of the Look-AHEAD (Action for Health in Diabetes) trial, showing racial and social-economic status disparities in the use of innovative glucose lowering medications (ie, DPP-4i, or SGLT-2i or GLP-1RAs). 68 Beyond the analyses of pattern of GLP-1RAs use by race/ethnic group, there is a lack of data on RWS evaluating the effectiveness of GLP-1RAs in these populations, underlining therefore the need for further RCTs and RWS on this aspect.…”

Retrospective, cohort review of pharmacists' impact on disparities in care in the management of type 2 diabetes with glucagon‐like peptide‐1 agonists and sodium glucose co‐transporter 2 inhibitors

“…Therefore, the pharmacist comanaged group does not include confounding factors of different family medicine providers. While the Look AHEAD study included DPP‐4 inhibitors, these agents were not included in this study because these agents have not been shown to have the cardiovascular benefit or renal protective features of GLP‐1 agonists and SGLT‐2 inhibitors 6 . They also are considered more weight neutral than other medication classes and are not emphasized by the guidelines for common comorbidities 2 .…”

“…They also are considered more weight neutral than other medication classes and are not emphasized by the guidelines for common comorbidities 2 . Therefore, it was decided to not include these agents, despite their inclusion in the secondary analysis of the Look AHEAD trial 6 …”

“…Many secondary analyses have been conducted, including one that evaluated the prescribing rates of SGLT‐2 inhibitors, GLP‐1 agonists, and dipeptidyl peptidase‐4 (DPP‐4) inhibitors. This study found that Black race was associated with significantly lower initiation of GLP‐1 agonists, SGLT‐2 inhibitors, and DPP‐4 inhibitors compared with White race (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.80‐0.94) 6 . It also found that lower yearly income was associated with significantly lower initiation of these same diabetes medications (HR: 0.69; 95% CI: 0.55‐0.87) 6 …”

“…Therefore, guideline‐directed therapy would suggest a higher prescribing rate of GLP‐1 agonists and SGLT‐2 inhibitors in this patient population given these findings. The Look AHEAD Trial evaluated intensive lifestyle interventions in people with diabetes 6 . Many secondary analyses have been conducted, including one that evaluated the prescribing rates of SGLT‐2 inhibitors, GLP‐1 agonists, and dipeptidyl peptidase‐4 (DPP‐4) inhibitors.…”