Socioeconomic aspects of incretin-based therapy

Abstract

Incretin-based therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have demonstrated cardiovascular benefits in people with type 2 diabetes. However, socioeconomic disparities in their uptake may constrain the collective advantages offered by these medications to the broader population. In this review we examine the socioeconomic disparities in the utilisation of incretin-based therapies and discuss strategies to address these inequalities. Based on real-world evidence, the uptake of GLP-1 RAs is reduced in people who live in socioeconomically disadvantaged areas, have low income and education level, or belong to racial/ethnic minorities, even though these individuals have a greater burden of type 2 diabetes and cardiovascular disease. Contributing factors include suboptimal health insurance coverage, limited accessibility to incretin-based therapies, financial constraints, low health literacy and physician–patient barriers such as provider bias. Advocating for a reduction in the price of GLP-1 RAs is a pivotal initial step to enhance their affordability among lower socioeconomic groups and improve their value-for-money from a societal perspective. By implementing cost-effective strategies, healthcare systems can amplify the societal benefits of incretin-based therapies, alongside measures that include maximising treatment benefits in specific subpopulations while minimising harms in vulnerable individuals, increasing accessibility, enhancing health literacy and overcoming physician–patient barriers. A collaborative approach between governments, pharmaceutical companies, healthcare providers and people with diabetes is necessary for the effective implementation of these strategies to enhance the overall societal benefits of incretin-based therapies. Graphical Abstract

Outcomes of Type 2 Diabetes Management: One Center Experience 2015–2023

“…Changes in body mass usually took place among marginal side effects of inappropriate diet and lifestyle [17]. On the other hand, changes of current amount of adipose and muscle tissues in the body are associated with availability of endogenous and/or injected insulin along with production of incretins in gut or their therapeutic administering and/or the sensitivity of respective receptors [18][19][20][21][22][23][24][25][26][27][28].…”

“…In addition, hyperglycemia is supported by escalated activity of SGLT2 in kidneys, resulting in increased reabsorption of glucose from primary urine. So, euglycemia, optimal body mass and normal lipoproteinemia may be regulated using insulin and/or incretin preparations and/or gliflozins and other medication without delay [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…Important papers are cited throughout the entire chapter. Several studies focused on individual drug classes such as insulin preparations [5][6][7][8][9][10][11][12]17], incretin preparations [13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29] and gliflozins [30][31][32][33][34]. New technologies such as SMPG [4], CGM [7,37,38], insulin pens [8] and CSII [5,6] became a part of daily routine.…”

Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials

“…However, it is essential to consider the broader implications of adopting these therapies in real-world settings, particularly concerning their cost. Observational data suggest a notable under-utilisation of GLP-1 RAs among individuals in lower socioeconomic groups, primarily due to the high cost of these medications, highlighting the disparity in access to effective diabetes treatments based on socioeconomic factors [ 63 ]. From a broader societal perspective, even though s.c. tirzepatide has been suggested to be cost-effective compared with s.c. semaglutide in the USA [ 64 ], cost-effectiveness analyses conducted in low-, middle- and high-income countries have demonstrated that GLP-1 RAs are not cost-effective compared with other glucose-lowering drugs [ 63 ].…”

Role of lifestyle and glucagon‐like peptide‐1 receptor agonists for weight loss in obesity, type 2 diabetes and steatotic liver diseases

“…Of note, the availability and uptake of incretin-based therapies depend highly on socioeconomic disparities and currently cannot address the full scale of the obesity pandemic. 264,265 Thus, it remains of paramount relevance to further develop new approaches to behavioural therapy and to create innovative incentives to engage people in a healthy lifestyle.…”