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DC22-0383 Supplemental_Appendix_-_Disparities_in_GLP1_SGLT2_-_FINAL.docx (241.4 kB)

Deficits and Disparities in Early Uptake of GLP-1 Receptor Agonists and SGLT2 Inhibitors among Medicare-insured Adults Following a New Diagnosis of Cardiovascular Disease or Heart Failure

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posted on 2022-11-16, 17:43 authored by Sara J. Cromer, Julie C. Lauffenburger, Raisa Levin, Elisabetta Patorno

  

Objective: To examine the association of race/ethnicity and socioeconomic deprivation with initiation of guideline-recommended diabetes medications with cardiovascular benefit (glucagon-like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose co-transporter-2 inhibitors (SGLT2i)) among older adults with type 2 diabetes (T2D) and either incident atherosclerotic cardiovascular disease (ASCVD) or congestive heart failure (CHF).

Research Design and Methods: Using Medicare data (2016-2019), we identified 4,057,725 individuals over age 65 with T2D and either incident ASCVD or CHF. We estimated incidence rates (IR) and hazard ratios (HR) of GLP1-RA or SGLT2i initiation within 180 days by race/ethnicity and zip code-level Social Deprivation Index (SDI) using adjusted Cox proportional hazards models. 

Results: IRs of GLP1-RA or SGLT2i initiation increased over time but remained low (<0.6 initiations per 100 person-months) in all years studied. Medication initiation was less common among those of Black or Other race/ethnicity (HR 0.81 [95% confidence interval (CI) 0.79-0.84] and HR 0.84 [95%CI 0.75-0.95], respectively) and decreased with increasing SDI (HR 0.96 [95%CI 0.96-0.97]). Initiation was higher in ASCVD than CHF (0.35 vs. 0.135 initiations per 100 person-months). Moderate (e.g., nephropathy, non-alcoholic fatty liver disease) but not severe (e.g., advanced chronic kidney disease, cirrhosis) comorbidities were associated with higher probability of medication initiation.

Conclusions: Among older adults with T2D and either ASCVD or CHF, initiation of GLP1-RA or SGLT2i was low, suggesting a substantial deficit in delivery of guideline-recommended care or treatment barriers. Individuals of Black and Other race/ethnicity and those with higher area-level socioeconomic deprivation were less likely to initiate these medications.

Funding

U.S. Department of Health and Human Services > National Institutes of Health > National Heart, Lung, and Blood Institute K01HL14153

U.S. Department of Health and Human Services > National Institutes of Health > National Institute of Diabetes and Digestive and Kidney Diseases F32DK127545

U.S. Department of Health and Human Services > National Institutes of Health > National Institute on Aging K08AG055670

Patient-Centered Outcomes Research Institute DB-2020C2-20326

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