Sex and Socioeconomic Differences in the Initiation of SGLT2 Inhibitors and GLP ‐1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study

AIMS: Cardioprotective glucose-lowering drugs (GLDs) remain underutilised in individuals with Type 2 diabetes (T2D) and cardiovascular disease (CVD). We aimed to estimate the association between sex and socioeconomic status and initiation of cardioprotective GLDs and to identify factors associated with non-initiation of cardioprotective GLDs. MATERIALS AND METHODS: Using Danish health registries, we identified individuals with both T2D and CVD between 2015 and 2022. Initiation of cardioprotective GLDs, sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) were assessed by sex and socioeconomic status. We estimated crude cumulative proportions, incidence rates (IR) and adjusted incidence rate ratios (IRR). Risk factors for non-initiation were analyzed using poisson regression. RESULTS: Among 81 361 individuals with newly diagnosed concomitant T2D and CVD (37% women), crude initiation rates of GLDs per 1000 person-years increased with higher educational level. This gradient disappeared after multivariable adjustment, with IRRs for females 0.95 (95% CI: 0.86-1.05) and males 1.00 (95% CI: 0.94-1.07). Marital and occupational status showed clear associations: compared with employed women, IRRs for initiation were 0.81 (95% CI: 0.75-0.88) for unemployed and 0.88 (95% CI: 0.79-0.97) for retired women. Compared with employed men, IRRs for unemployed and retired men were 0.77 (95% CI: 0.73-0.81) and 0.83 (95% CI: 0.78-0.88), respectively. Divorced, widowed and unmarried individuals also had lower IRR than married individuals. CONCLUSION: Among individuals with newly diagnosed T2D and CVD, lower initiation of guideline-recommended cardioprotective GLDs was observed among individuals with low socioeconomic status in both men and women.