Introduction and Objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) provide glycemic, cardiovascular, and renal benefits for individuals with type 2 diabetes (T2D). Prior studies suggest lower prescribing rates among women, but many lack adjustment for key clinical factors. We aimed to determine whether sex assigned at birth was associated with disparities in SGLT2i prescription rates among adults with T2D with similar clinical characteristics. Methods: We conducted a retrospective cohort study of adults aged ≥18 years with T2D receiving care within an integrated academic health system from January 2021 to December 2024. The exposure was sex assigned at birth, and the outcome was receipt of any SGLT2i prescription during the study period. Covariates included age, maximum body mass index (BMI) and hemoglobin A1c, atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), median estimated glomerular filtration rate (eGFR), diabetes medication history, race and ethnicity, Social Deprivation Index, and proximity of care. Overlap weighting using propensity scores was applied to balance covariates between sexes. We used binomial regression to estimate adjusted risk ratios (RR) and risk differences (RD). Results: We included 100,555 adults with T2D (48% female, 52% male). Median (IQR) age was 63.9 (54.6, 72.6) years, BMI 32.2 (28.1, 37.3) kg/m², and A1c 7.1 (6.5, 8.3)%; 23% had ASCVD, 9% HF, and 6% CKD. Before weighting, SGLT2i prescribing was 32% lower for women than men (15% vs 22%). After weighting, SGLT2i prescribing was found to be 23% lower for women than men (adjusted RR= 0.77; 95% CI 0.75, 0.80; adjusted RD= −4.7%; −5.2%, −4.2%). Conclusion: Females living with T2D were significantly less likely to receive SGLT2 inhibitors than males with similar clinical profiles. These findings highlight persistent sex-based inequities in evidence-based diabetes care Disclosure A. Khan: None. D.C. Soria: None. D. Pant: None. S. Hsu: None. Y. Fu: None. T. Thaweethai: None. C.M. Mitchell: Consultant; Ended; Freya Biosciences, DIVA, Inc. Advisory Panel; Ended; GlaxoSmithKline plc. Stock/Shareholder; Current; Ancilia Biosciences. Advisory Panel; Current; Concerto Biosciences. C. Powe: Research Support; Current; Dexcom, Inc. Other - Associate Editor of Diabetes Care, Honoraria for Educational Materials; Current; American Diabetes Association. Other - Royalties for Up To Date chapters; Current; Wolters Kluwer (Up To Date). Other - Speaker; Ended; Medscape.
Khan et al. (Fri,) studied this question.