Deficits and Disparities in Early Uptake of Glucagon-Like Peptide 1 Receptor Agonists and SGLT2i Among Medicare-Insured Adults Following a New Diagnosis of Cardiovascular Disease or Heart Failure.

Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE

Publication: Alexandria Va : American Diabetes Association
Original Publication: New York, American Diabetes Assn.

Cardiovascular Diseases*/epidemiology ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/epidemiology ; Heart Failure*/drug therapy ; Heart Failure*/epidemiology ; Atherosclerosis*; United States/epidemiology ; Aged ; Humans ; Medicare ; Glucagon-Like Peptide 1 ; Glucagon-Like Peptide-1 Receptor ; Hypoglycemic Agents

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 cotransporter 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 age >65 years with T2D and either incident ASCVD or CHF. We estimated incidence rates 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: Incidence rates 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% 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, nonalcoholic 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.
(© 2022 by the American Diabetes Association.)

JAMA Netw Open. 2021 Apr 1;4(4):e216139. (PMID: 33856475)
Curr Med Res Opin. 2013 Nov;29(11):1495-502. (PMID: 23944631)
Diabetes Care. 2018 Dec;41(12):2669-2701. (PMID: 30291106)
J Gen Intern Med. 2022 Nov;37(14):3562-3569. (PMID: 35048301)
Health Serv Res. 2013 Apr;48(2 Pt 1):539-59. (PMID: 22816561)
N Engl J Med. 2019 Aug 29;381(9):841-851. (PMID: 31185157)
Lancet Reg Health Eur. 2022 Jan 25;14:100308. (PMID: 35146474)
J R Soc Med. 2011 Dec;104(12):510-20. (PMID: 22179294)
J Am Coll Cardiol. 2019 Oct 22;74(16):2032-2043. (PMID: 31623760)
Lancet. 2019 Jul 13;394(10193):121-130. (PMID: 31189511)
N Engl J Med. 2016 Jul 28;375(4):311-22. (PMID: 27295427)
J Diabetes Complications. 2022 Jun;36(6):108204. (PMID: 35537891)
Health Care Financ Rev. 2003 Winter;25(2):63-76. (PMID: 15124378)
J Diabetes Res. 2013;2013:575814. (PMID: 23671877)
Med Care. 2020 Jan;58(1):e1-e8. (PMID: 31688554)
Diabetes Res Clin Pract. 2021 May;175:108825. (PMID: 33887352)
N Engl J Med. 2019 Jan 24;380(4):347-357. (PMID: 30415602)
Diabetes Obes Metab. 2018 Jan;20(1):103-112. (PMID: 28656746)
N Engl J Med. 2016 Nov 10;375(19):1834-1844. (PMID: 27633186)
J Hypertens. 2021 Jun 1;39(6):1238-1245. (PMID: 33560056)
J Am Acad Nurse Pract. 2008 Nov;20(11):555-62. (PMID: 19128339)
N Engl J Med. 2017 Aug 17;377(7):644-657. (PMID: 28605608)
J Gerontol A Biol Sci Med Sci. 2019 Jul 12;74(8):1271-1276. (PMID: 30165612)
J Clin Epidemiol. 2011 Jul;64(7):749-59. (PMID: 21208778)
JAMA Health Forum. 2021 Dec 17;2(12):e214182. (PMID: 35977298)
Diabetes Technol Ther. 2021 Apr;23(4):306-313. (PMID: 33155826)
J Am Heart Assoc. 2020 Jun 2;9(11):e014742. (PMID: 32431190)
N Engl J Med. 2000 Apr 20;342(16):1163-70. (PMID: 10770981)
N Engl J Med. 2015 Nov 26;373(22):2117-28. (PMID: 26378978)
BMC Health Serv Res. 2014 Oct 20;14:469. (PMID: 25331607)
J Am Heart Assoc. 2021 Jan 19;10(2):e016835. (PMID: 33432843)
PLoS Med. 2019 Oct 7;16(10):e1002942. (PMID: 31589609)
Diabetes Care. 2020 Feb;43(2):487-493. (PMID: 31857443)
Am Heart J. 2009 Apr;157(4):754-62.e2. (PMID: 19332206)
N Engl J Med. 2017 Sep 28;377(13):1228-1239. (PMID: 28910237)
BMC Med. 2021 Aug 31;19(1):189. (PMID: 34461899)
J Am Heart Assoc. 2021 Jul 6;10(13):e021084. (PMID: 33998258)
N Engl J Med. 2003 Jun 26;348(26):2635-45. (PMID: 12826639)
Acad Emerg Med. 2008 May;15(5):414-8. (PMID: 18439195)
Diabetes Care. 2022 Feb 1;45(2):372-380. (PMID: 35015080)
Front Public Health. 2017 Sep 12;5:235. (PMID: 28955703)

T32 DK007028 United States DK NIDDK NIH HHS; K08 AG055670 United States AG NIA NIH HHS; U01 FD007213 United States FD FDA HHS; K01 HL141538 United States HL NHLBI NIH HHS; F32 DK127545 United States DK NIDDK NIH HHS

89750-14-1 (Glucagon-Like Peptide 1)
0 (Glucagon-Like Peptide-1 Receptor)
0 (Hypoglycemic Agents)

Date Created: 20221116 Date Completed: 20221226 Latest Revision: 20240102

20240102

PMC9797651

10.2337/dc22-0383

36383481