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
Authors' conclusion
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.
Study context
- Population
- Medicare-insured adults age >65 years with T2D and incident atherosclerotic CVD (atherosclerotic cardiovascular disease (ASCVD)) or congestive HF (congestive heart failure (CHF)), 2016–2019
- Participants
- 4,057,725 participants
- Exposure
- Initiation of GLP-1 RA or SGLT2i by race/ethnicity and zip code-level Social Deprivation Index (SDI)
- Outcome
- GLP-1 RA or SGLT2i initiation
- Follow-up
- Within 180 days
Methodological detailsadjusted Cox proportional hazards models
- Adjusted Cox proportional hazards models
Main finding
As reported in the abstract
Hazard ratio (95% CI)
Black race/ethnicityless common
0.81(0.79–0.84)
Other race/ethnicityless common
0.84(0.75–0.95)
Increasing SDI
0.96(0.96–0.97)
- Incidence rates of initiation increased over time but remained low in all years studied
- <0.6 initiations per 100 person-months
Observational data: associations, not effects.
Further findings
| Outcome | ASCVD | CHF |
|---|---|---|
| Initiation by conditionInitiations per 100 person-months | 0.35 | 0.135 |
Comorbidities
- Moderate (e.g., nephropathy, NAFLD) but not severe (e.g., advanced CKD, cirrhosis) comorbidities associated with higher probability of initiation
Original publication
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. Diabetes Care. Published 16 November 2022. doi:10.
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