What does this research mean for the field?

Black and Hispanic older adults with type 2 diabetes and cardiorenal conditions experience significant disparities in the initiation of SGLT2 inhibitors and GLP-1 receptor agonists compared to White adults, although these disparities have decreased over time. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate racial and ethnic disparities in the initiation of SGLT2 inhibitors and GLP-1 receptor antagonists among older Medicare beneficiaries with type 2 diabetes and cardiorenal conditions.

November 8, 2024DiabetologiaOpen Access

Racial and ethnic disparities in the uptake of SGLT2is and GLP-1RAs among Medicare beneficiaries with type 2 diabetes and heart failure, atherosclerotic cardiovascular disease and chronic kidney disease, 2013–2019

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Why the study?

The study aimed to investigate racial and ethnic disparities in the use of SGLT2is and GLP-1RAs among older adults with type 2 diabetes and cardiorenal conditions.

Are there racial and ethnic disparities in the initiation of SGLT2 inhibitors and GLP-1 receptor agonists among older adults with type 2 diabetes and cardiorenal conditions?

Population

Medicare beneficiaries aged ≥65 with type 2 diabetes initiating second-line therapies with or without cardiorenal conditions

Comparison

Non-Hispanic Black and Hispanic participants vs non-Hispanic White participants

Design

Retrospective cohort study

Authors

EWEric WangRutgers, The State University of New Jersey EPElisabetta PatornoBroad Institute FKFarzin Khosrow‐KhavarRutgers, The State University of New Jersey

Discussion

Member takes

Implication

Racial disparities in SGLT2i initiation were observed; leaves open whether equity interventions can improve access in cardiorenal care.

Key Points

To evaluate racial and ethnic disparities in the initiation of SGLT2 inhibitors and GLP-1 receptor antagonists among older Medicare beneficiaries with type 2 diabetes and cardiorenal conditions.
Retrospective cohort study analyzing Medicare fee-for-service claims from 2013 to 2019 among beneficiaries aged ≥65 years with type 2 diabetes initiating second-line therapies.
Assessed four clinical cohorts: heart failure (HF), atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and no recorded cardiorenal conditions.
Employed multinomial regression models adjusting for sociodemographic, clinical, and county-level characteristics to determine odds of drug initiation among non-Hispanic White, non-Hispanic Black, and Hispanic individuals.
Non-Hispanic Black beneficiaries had significantly lower odds of initiating SGLT2is than White beneficiaries across all cohorts (HF: adjusted OR 0.65, 95% CI 0.61–0.68; ASCVD: adjusted OR 0.67, 95% CI 0.64–0.69; CKD: adjusted OR 0.68, 95% CI 0.64–0.72), though disparities narrowed from 2013 to 2019.
Hispanic beneficiaries had lower odds of GLP-1RA initiation across all cohorts compared to White beneficiaries (HF: adjusted OR 0.89, 95% CI 0.84–0.94; ASCVD: adjusted OR 0.84, 95% CI 0.81–0.87; CKD: adjusted OR 0.84, 95% CI 0.80–0.89).
Minority beneficiaries were more likely than White beneficiaries to initiate DPP4is across all cohorts (HF: adjusted OR 1.25, 95% CI 1.19–1.31; ASCVD: adjusted OR 1.36, 95% CI 1.32–1.40; CKD: adjusted OR 1.32, 95% CI 1.26–1.38), despite their lack of cardiorenal benefits.

Structured PICO

Are there racial and ethnic disparities in the initiation of SGLT2 inhibitors and GLP-1 receptor agonists among older adults with type 2 diabetes and cardiorenal conditions?

Population

Older adults (≥65 years) with type 2 diabetes initiating second-line therapies (SGLT2is, GLP1-RAs, DPP4is, and sulfonylureas) with (1) heart failure (HF), (2) atherosclerotic cardiovascular disease (ASCVD), (3) chronic kidney disease (CKD), and (4) no recorded cardiorenal conditions, classified as non-Hispanic White, non-Hispanic Black, and Hispanic.

Intervention

Initiation of SGLT2 inhibitors or GLP-1 receptor agonists

Comparator

Non-Hispanic White participants (reference group for racial/ethnic comparison)

Outcome

Odds of initiating SGLT2is or GLP-1RAs

Significant racial and ethnic disparities exist in the prescription of SGLT2 inhibitors and GLP-1 receptor agonists among older Medicare beneficiaries with type 2 diabetes and cardiorenal conditions, with Black and Hispanic patients having lower odds of receiving these therapies compared to White patients.

Cite This Study

Wang et al. (2024) studied this question.

synapsesocial.com/papers/6a1bde674ebd09f3dfa92136 https://doi.org/10.1007/s00125-024-06321-2

Topics

HFrEF treatment Heart failure SGLT2 inhibitors in heart failure HFpEF management GLP-1 agonists cardiovascular outcomes Retatrutide

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Racial and ethnic disparities in the uptake of SGLT2is and GLP-1RAs among Medicare beneficiaries with type 2 diabetes and heart failure, atherosclerotic cardiovascular disease and chronic kidney disease, 2013–2019

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Racial and ethnic disparities in the uptake of SGLT2is and GLP-1RAs among Medicare beneficiaries with type 2 diabetes and heart failure, atherosclerotic cardiovascular disease and chronic kidney disease, 2013–2019

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider