Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System.

Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE

Original Publication: Chicago : American Medical Association, 1960-

Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/ethnology ; Glucagon-Like Peptide-1 Receptor*/agonists ; Healthcare Disparities*/ethnology ; Healthcare Disparities*/statistics & numerical data ; Prescriptions*/statistics & numerical data ; Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use ; Veterans Health*/ethnology ; Veterans Health*/statistics & numerical data; Adult ; Aged ; Cross-Sectional Studies ; Ethnicity/statistics & numerical data ; Female ; Health Equity/statistics & numerical data ; Humans ; Hypoglycemic Agents/therapeutic use ; Male ; Practice Patterns, Physicians'/statistics & numerical data ; Professional Practice/statistics & numerical data ; Racial Groups/statistics & numerical data ; United States/epidemiology

Importance: Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents' prescription across racial and ethnic groups has not been well-evaluated.
Objective: To investigate differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups.
Design, Setting, and Participants: Cross-sectional analysis of data from the US Veterans Health Administration's Corporate Data Warehouse. The sample included adult patients with type 2 diabetes and at least 2 primary care clinic visits from January 1, 2019, to December 31, 2020.
Exposures: Self-identified race and self-identified ethnicity.
Main Outcomes and Measures: The primary outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active prescription during the study period.
Results: Among 1 197 914 patients (mean age, 68 years; 96% men; 1% American Indian or Alaska Native, 2% Asian, Native Hawaiian, or Other Pacific Islander, 20% Black or African American, 71% White, and 7% of Hispanic or Latino ethnicity), 10.7% and 7.7% were prescribed an SGLT2i or a GLP-1 RA, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 8.4% among American Indian or Alaska Native patients; 11.8% and 8% among Asian, Native Hawaiian, or Other Pacific Islander patients; 8.8% and 6.1% among Black or African American patients; and 11.3% and 8.2% among White patients, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 7.1% among Hispanic or Latino patients and 10.7% and 7.8% among non-Hispanic or Latino patients. After accounting for patient- and system-level factors, all racial groups had significantly lower odds of SGLT2i and GLP-1 RA prescription compared with White patients. Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio, 0.72 [95% CI, 0.71-0.74] for SGLT2i and 0.64 [95% CI, 0.63-0.66] for GLP-1 RA). Patients of Hispanic or Latino ethnicity had significantly lower odds of prescription (0.90 [95% CI, 0.88-0.93] for SGLT2i and 0.88 [95% CI, 0.85-0.91] for GLP-1 RA) compared with non-Hispanic or Latino patients.
Conclusions and Relevance: Among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.

Comment in: JAMA. 2022 Sep 6;328(9):836-838. (PMID: 36066540)

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K99 HL157721 United States HL NHLBI NIH HHS; P30 AG015272 United States AG NIA NIH HHS; K24 AG067003 United States AG NIA NIH HHS; K23 DK119562 United States DK NIDDK NIH HHS; P30 MH062246 United States MH NIMH NIH HHS

0 (Glucagon-Like Peptide-1 Receptor)
0 (Hypoglycemic Agents)
0 (Sodium-Glucose Transporter 2 Inhibitors)

Date Created: 20220906 Date Completed: 20220908 Latest Revision: 20230614

20230614

PMC9449794

10.1001/jama.2022.13885

36066519