Racial and ethnic disparities in the uptake of SGLT2is and GLP-1RAs among Medicare beneficiaries with type 2 diabetes and heart failure, atherosclerotic cardiovascular disease and chronic kidney disease, 2013–2019
Authors' conclusion
Compared with White participants, disparities in the uptake of SGLT2is were evident for Black participants, and in the uptake of GLP-1RAs for both Black and Hispanic participants. This study highlights how type 2 diabetes management is evolving, while underscoring historical imbalances that have shown signs of abatement.
Study context
- Population
- Older adults (≥65 years) with T2D initiating second-line therapies (SGLT2is, GLP-1 RAs, DPP-4is, SUs), in cohorts with heart failure (HF), atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) or no recorded cardiorenal conditions; Medicare fee-for-service, 2013–2019
- Exposure
- Non-Hispanic Black and Hispanic vs non-Hispanic White participants: initiation of SGLT2i or GLP-1 RA
- Outcome
- Odds of initiating SGLT2is or GLP-1 RAs within each cohort
Methodological detailsMedicare fee-for-service data, multinomial regression adjusted for sociodemographic, clinical and county-level characteristics
- Medicare fee-for-service data
- Multinomial regression adjusted for sociodemographic, clinical and county-level characteristics
Main finding
As reported in the abstract
SGLT2i initiation, Black vs White
Black vs WhiteEstimate (95% CI)
35% lower odds
aOR (HF cohort) 0.65(0.61–0.68)
33% lower odds
aOR (ASCVD cohort) 0.67(0.64–0.69)
32% lower odds
aOR (CKD cohort) 0.68(0.64–0.72)
24% lower odds
aOR (no cardiorenal conditions cohort) 0.76(0.74–0.79)
- Disparities ameliorated from 2013 to 2019 (lower odds)
- 50-60% in 2013 to 17-18% in 2019
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| SGLT2i initiation, Hispanicvs White6% lower odds | aOR (ASCVD cohort) 0.94 (CI 0.91–0.98) | |
| GLP-1 RA initiation, Hispanic vs WhiteHispanicvs White11% lower odds | aOR (HF cohort) 0.89 (CI 0.84–0.94) | |
| GLP-1 RA initiation, Hispanic vs WhiteHispanicvs White16% lower odds | aOR (ASCVD cohort) 0.84 (CI 0.81–0.87) | |
| GLP-1 RA initiation, Hispanic vs WhiteHispanicvs White16% lower odds | aOR (CKD cohort) 0.84 (CI 0.80–0.89) | |
| GLP-1 RA initiation, Hispanic vs WhiteHispanicvs White25% lower odds | aOR (no cardiorenal conditions cohort) 0.75 (CI 0.72–0.78) | |
| 0.512Ratio (log scale) |
GLP-1 RA initiation, Black vs White
- Similar patterns were observed for GLP-1RA uptake among Black participants
SGLT2i initiation, Hispanic vs White
- Similar odds of SGLT2i initiation in the HF and CKD cohorts
DPP-4i initiation vs White participants (group as printed: 'Participants')
- Greater odds of initiating DPP-4is, HF cohort
- 1.25 [1.19, 1.31]
- Greater odds of initiating DPP-4is, ASCVD cohort
- 1.36 [1.32, 1.40]
- Greater odds of initiating DPP-4is, CKD cohort
- 1.32 [1.26, 1.38
- The abstract does not state which group these odds refer to
Adjustment for social determinants of health
- Did not meaningfully change the study findings
Original publication
Racial and ethnic disparities in the uptake of SGLT2is and GLP-1RAs among Medicare beneficiaries with type 2 diabetes and heart failure, atherosclerotic cardiovascular disease and chronic kidney disease, 2013–2019. Diabetologia. Published 8 November 2024. doi:10.
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