Sociodemographic disparities in the use of GLP-1 receptor agonists and SGLT-2 inhibitors among US adults with type 2 diabetes: NHANES 2005-March 2020

Abstract

Aim: Type 2 Diabetes (T2D) is a major cause of morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are highly effective but underutilized. We assessed racial/ethnic and other sociodemographic disparities in GLP-1/SGLT-2 use among US adults with T2D. Materials and Methods: We conducted a retrospective analysis using nationally representative data from National Health and Nutrition Examination Survey 2005-March 2020. Participants were adults with T2D taking ≥1 diabetes medication, excluding pregnant women and adults with probable T1D. We performed univariate analyses to examine characteristics of patients using GLP-1/SGLT-2 and multivariable logistic regression to assess disparities in GLP-1/SGLT-2 use after adjusting for other patient factors. Results: Among 4,585 T2D patients (representing >18 million US adults) taking ≥1 medication, GLP-1/SGLT-2 usage increased from 1.4% in 2005-2006 to 13.3% in 2017-2020. In univariate analyses, patients using GLP-1/SGLT-2 vs. other T2D drugs were more likely to be white than nonwhite (72% vs. 60%, p = .001), but in multivariable analysis there was no significant difference in GLP-1/SGLT-2 use for nonwhite vs. white patients (aOR = 0.84, 95% CI [0.61, 1.16]). GLP-1/SGLT-2 use was higher for patients who completed some college (aOR = 1.83, 95% CI [1.06, 3.15]) or above (aOR = 2.06, 95% CI [1.28, 3.32]) vs. high school or less, and for those with an income-poverty ratio ≥4 vs. <2 (aOR = 2.11, 95% CI [1.30, 3.42]). Conclusions: Use of GLP-1/SGLT-2 drugs increased over time but remained low in March 2020. Higher education and income, but not race/ethnicity, were associated with GLP-1/SGLT-2 use.

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

“…We should monitor for the potential of unintended consequences that may lead to systematically underestimating risk in disenfranchised groups who may already be less likely to be appropriately prescribed evidence-based medications (eg, statins, novel glucose-lowering drugs) to reduce CVD risk. [154][155][156] Therefore, calibration of PREVENT across key sociodemographic subgroups (eg, race and ethnicity, strata of social deprivation index) was carefully assessed and demonstrated good calibration among Black individuals (base PREVENT equations calibration slope 1.11 [0.79-1.24]).…”