Introduction: Despite evidence from clinical trials showing the cardiovascular benefits of select GLP-1 receptor agonists and SGLT2 inhibitors in patients with type 2 diabetes mellitus (T2DM), uptake has been limited. We investigated the demographic, socioeconomic, and healthcare access factors associated with the use of these medications among insured adults with T2DM and high atherosclerotic cardiovascular disease (ASCVD) risk to identify potential barriers among those with access to care. Methods: Cross-sectional data from the 2021-2023 Medical Expenditure Panel Surveys were used to identify insured adults aged ≥ 18 years old with T2DM at high ASCVD risk, defined as having established ASCVD or ≥ 2 risk factors for ASCVD (hypertension, dyslipidemia, smoking). The primary analysis evaluated associations among demographic, socioeconomic, and healthcare access factors and the use of cardioprotective GLP-1 receptor agonists and SGLT2 inhibitors through multivariable logistic regression. A secondary analysis examined the role of patient-provider interaction factors and use of these medications among subjects with a usual healthcare provider. Results: Of the 5,536 adults with T2DM and high ASCVD risk, 56.9% were aged ≥ 65 years, 53.7% were male, and 59.8% were non-Hispanic White. In multivariable models, age ≥ 65 years (vs. age 18-44 years; OR 0.60; 95% CI 0.42-0.86), identifying as non-Hispanic Black (vs. non-Hispanic White; OR 0.74; 95% CI 0.58-0.95), having less than a high school graduate education (vs. college or more; OR 0.63; 95% CI 0.47-0.85), having low income (vs. high income; OR 0.71; 95% CI 0.57-0.86), and having no usual healthcare provider (OR 0.71; 95% CI 0.54-0.94) were associated with significantly lower odds of using a cardioprotective GLP-1 receptor agonist or SGLT2 inhibitor. There was no association for insurance type. Among the 4,831 adults with a usual healthcare provider, reporting that the provider explained all treatment options was associated with higher odds of using cardioprotective GLP-1 receptor agonists or SGLT2 inhibitors, though the relationship was not statistically significant (OR 1.38; 95% CI 0.88-2.18). Conclusions: Sociodemographic disparities were observed in the use of cardioprotective GLP-1 receptor agonists and SGLT2 inhibitors among insured adults with T2DM and high ASCVD risk. Further research is warranted to determine whether enhancing shared decision-making between patients and providers can promote use of these therapies.
Hwang et al. (Tue,) studied this question.