2909-LB: Longitudinal Analysis of Variation by Race and Ethnicity in Prescription of GLP-1RA and SGLT2i Medications in Type 2 Diabetes

Introduction and Objective: GLP-1RA and SGLT2i classes reduce glycemia, improve cardiometabolic risk factors, and cardiovascular and renal disease risk for adults with type 2 diabetes. However, Hispanic, Black, and Asian populations are less likely to initiate the drugs than non-Hispanic White patients. Our objective was to assess longitudinal trends in prescription of GLP-1RA and SGLT2i medications by race and ethnicity from 2016-2023. Methods: We analyzed EHR data from adults with type 2 diabetes with at least one indication for GLP-1RA or SGLT2i - 1) CVD or DKD, 2) obesity, or 3) high HbA1c (above 8%). We used cluster-robust linear probability modeling with a primary outcome of receiving a prescription for GLP-1RA or SGLT2i, analyzed as a composite endpoint and separately. Our primary predictor was race/ethnicity, with a race-by-calendar-year interaction term. Results: Our sample included 6,607 adults with 27,243 person-years. In 2016, Black adults had an 8.1% lower rate of prescribing than non-Hispanic White patients (p0.001), with the gap evenly distributed between GLP-1RA and SGLT2i. Hispanic and Asian adults had similar rates to non-Hispanic White patients. Asian patients experienced significantly slower increase in GLP-1RA prescriptions during 2021-2023 (p0.01). Rates of prescription for Hispanic and Black patients did not change significantly relative to non-Hispanic White patients over time. Conclusion: Black patients had significantly lower prescribing of GLP-1RA or SGLT2i in 2016-2018 and did not experience significant acceleration in prescribing rates in 2019-2023 compared to non-Hispanic White patients. Asian patients had less prescribing of GLP-1RA only in the 2021-2023 period. Utilization of effective new drug classes remains uneven across racial and ethnic groups with type 2 diabetes. Evaluation of interventions to ensure access to GLP-1RA and SGLT2i is needed to promote equitable prescribing and prevent widening disparities in outcomes. Disclosure H.A. Torres: None. T. Moin: None. N. Jackson: None. Y. Tsugawa: None. C. Mangione: None. Funding UCLA STAR Program