abstract
Objectives: To evaluate pharmacy dispensing of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) among patients with type 2 diabetes (T2D) over time and by race and ethnicity. Methods: This was a retrospective cohort study of patients ( ≥ 18 years) with T2D using 2014-2022 electronic health record data from 6 large US care delivery systems. Cohort entry was at earliest pharmacy dispensing of any T2D medication. We used logistic regression to evaluate the association between pharmacy dispensing of SGLT2i and GLP1-RA and race and ethnicity, adjusting for cardiovascular risk factors, clinical and demographic characteristics at baseline.
Results: Our cohort included 681,823 patients (median [IQR] age 60 [51,69]; 46.4% female; 16.6% Asian, 10.5% Black or African American, 1.4% Hawaiian or Pacific Islander (HPI), 31% Hispanic, 3.8% Multi-racial or Other/Unknown, 0.3% American Indian or Alaska Native (AI/AN), and 36.4% White). Patients were followed for a median [IQR] of 6 years [3,9]. The age, sex, and site adjusted rate of annual pharmacy dispensing of SGLT2i increased from 0.1% to 12.2% between 2014 and 2022 (Figure 1A) and increased from 0.3% to 3.8% for GLP1-RA (Figure 1B). In the fully adjusted models, SGLT2i dispensing was lower for AI/AN (OR 0.80, 95% CI 0.67-0.93), Black or African American (OR 0.89, 0.86-0.92) and Hispanic (OR 0.87, 0.85-0.89) compared to White adults. GLP1-RA dispensing was lower for AI/AN (OR 0.79, 0.63-0.97), Asian (OR 0.50, 0.48-0.52), Black or African American (OR 0.86, 0.83-0.90), HPI (OR 0.51, 0.46-0.57), Hispanic (OR 0.69, 0.66-0.71), and Multi-racial or Other/Unknown (OR 0.78, 0.73-0.83) compared to White adults.
Conclusions: Pharmacy dispensing of SGLT2i, and GLP1-RA medications was lower in patients with T2D from minority groups compared to White adults in 6 US large care delivery systems. This suggests the need for equitable interventions to narrow the race and ethnicity gap in the use of these drugs for cardiovascular outcomes in the US.
