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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
Open accessAbstract
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.
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“Compounding this significant underuse, Black, Hispanic/Latinx, and Asian individuals receive fewer prescriptions for these medications compared to White individuals.14–17”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [16]
In the citing paper
“Recent studies have also broadly shown racial and ethnic differences in SGLT2i and GLP1ra prescriptions with Black, Hispanic/Latinx, and Asian groups receiving these medications at lower rates than White individuals.14–17”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [16]
In the citing paper
“Consistent with our findings, other studies have demonstrated low rates of SGLT2i and GLP1ra medication use (11.2% and 8%, respectively), even among patients at high risk of cardiovascular disease.12–16,32”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [16]
In the citing paper
“Previous research has highlighted a pattern of treatment disparities that is consistent across various data sources [12–17].”
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Spinelli, K. J., & Oakes, A. H. (2025) · American Journal of Health Promotion · doi:10.1177/08901171251335507b · Cited by 4
Trends and Disparities in Deaths from Kidney Disease Among Older Adults in the United States
Grobman, B., Bondarchuk, C. P., Mansur, A., & Lu, C. Y. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14144950 · Cited by 6
“However, preliminary research suggests that Black patients are less likely than White patients to receive these therapies [34], raising concerns that inequities in treatment access may perpetuate or even widen existing disparities in kidney disease outcomes in the years ahead.”
Racial and ethnic disparities related to the Medicare Part D Medication Therapy Management Program
Allen, A., & Hung, A. (2024) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2024.30.6.609 · Cited by 4
Access to GLP-1s: Where Do Employers Fit in?
Imboden, M. T. (2025) · American Journal of Health Promotion · doi:10.1177/08901171251335507 · Cited by 4
Zhang, J., Spall, H. G. C. V., Li, L., Khan, M. S., Pandey, A., Thabane, L., Bai, X., Wang, Y., Lip, G. Y. H., & Li, G. (2023) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2023.102804 · Cited by 4
Shannon, E. M., Steers, W. N., & Washington, D. L. (2023) · Health Services Research · doi:10.1111/1475-6773.14260 · Cited by 3
Berg, K. A., Bharmal, N. H., Tereshchenko, L. G., Le, P., Payne, J. Y., Misra‐Hebert, A. D., & Rothberg, M. B. (2024) · Primary care diabetes · doi:10.1016/j.pcd.2024.02.004 · Cited by 5
Aroda, V. R., & Billings, L. K. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.06.005 · Cited by 4
Another Win for SGLT2 Inhibitors in Chronic Kidney Disease
Leaf, D. E., & Bansal, N. (2025) · New England Journal of Medicine · doi:10.1056/nejme2500233 · Cited by 4
Evidence-based SGLT2 inhibitor and GLP-1 receptor agonist use by race in the VA healthcare system
Bolden, D. M., Richardson, V., Salahuddin, T., Henderson, K., Hess, P. L., Raghavan, S., Saxon, D. R., Ho, P. M., Waldo, S. W., & Schwartz, G. G. (2025) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2025.100966 · Cited by 4
“However, a recent study in the VA healthcare system indicated that Black patients with T2D had significantly lower odds of being prescribed SGLT2i and GLP-1RA than White patients with T2D [23].”
InfluentialSteiger, K. G., SWARNA, K. S., Herrin, J. S., & McCoy, R. G. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09784-0 · Cited by 4
Müller, F., Bouthillier, M. J., Alshaarawy, O., Azhary, H., & Holman, H. T. (2025) · Journal of Diabetes Research · doi:10.1155/jdr/6656982 · Cited by 3
“They are also consistent with several studies that have reported lower odds of receiving prescriptions for these medications among certain racial and ethnic groups [27].”
Racial and demographic disparities in glp-1ra use among breast cancer patients with Type 2 Diabetes
Hundal, J., Ashruf, O. S., Li, H., Basen‐Engquist, K., Kaelber, D. C., & Sukumar, J. S. (2025) · npj Breast Cancer · doi:10.1038/s41523-025-00844-6 · Cited by 5
“80,95%CI,0.76-0.85) despitestandardizedaccess and limited cost-sharing 24 .”
InfluentialWeeda, E. R., Ward, R. C., Gebregziabher, M., Axon, R. N., & Taber, D. J. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-023-01619-0 · Cited by 3
Flattening the Playing Field for Treatment of Diabetic Kidney Disease
Norris, K. C., Williams, S. F., & Nee, R. (2023) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2023.151428 · Cited by 3
Use of Antihyperglycemic Medications Among US People with Limited English Proficiency
Müller, F., Holman, H. T., Bhangu, N., Kottutt, J., Azhary, H., & Alshaarawy, O. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09385-x · Cited by 2
Population Health Management for Improving Kidney Health Outcomes
Jhamb, M., Schell, J. O., Weltman, M. R., Lavenburg, L.-M. U., Puttarajappa, C. M., Fischer, G. S., & Kleyman, T. R. (2025) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2025.01.020 · Cited by 2
Petrosyan, R., Caballero, A. E., Henry, T. L., & Puchalski, A. R. (2025) · The Nephron journals/Nephron journals · doi:10.1159/000548904 · Cited by 2
“Similarly, Hispanic patients were 24% less likely to receive SGLT2i and 33% less likely to receive GLP-1RA than non-Hispanic White patients [11–14].”
Decker, S. R. D. R., Chaudhary, R. S., Inoue, K., Song, Y., Ndumele, C. E., Khan, S. S., & Kazi, D. S. (2025) · Diabetes Care · doi:10.2337/dc25-1619 · Cited by 2
Tailoring interventions to close gaps in diabetes mellitus care
Diaz-Thomas, A., Cabrera, S. M., Pereira, R. I., & Iyer, P. (2026) · Nature Reviews Endocrinology · doi:10.1038/s41574-025-01217-6 · Cited by 4
“Similar racial disparities are observed in prescription rates for the new classes of diabetes mellitus medications such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists 124 .”
Relationship between health system quality and racial and ethnic equity in diabetes care
Wong, M. S., Tseng, C., Moy, E. M., Jones, K. T., Kothari, A. J., & Washington, D. L. (2024) · Health Affairs Scholar · doi:10.1093/haschl/qxae073 · Cited by 2
Ananthesh, L., Cutinha, R. M., & Basutkar, R. S. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02410-z · Cited by 2
Yun, S., Hurren, K. M., Holleman, R. G., Klamerus, M. L., Tremblay, A. S., & Sussman, J. B. (2024) · Research Square · doi:10.21203/rs.3.rs-4025186/v1 · Cited by 2
Taylor, S., Zinabu, S., McMillan, E., Ocampo, E., Edmonds, A., Lyles, S., Pempeh, J., Yates, K., & Micheal, M. (2025) · Cureus · doi:10.7759/cureus.77159 · Cited by 1
“During 2019-2020, among patients with T2DM in the VA system, an integrated healthcare system with minimal medication cost-sharing and standardized guidelines, the prescription rates of SGLT2i were low [10].”
Ostrominski, J. W., Aroda, V. R., Braae, U. C., Kruse, C., Mandavya, K., & Buse, J. B. (2025) · Diabetes Therapy · doi:10.1007/s13300-025-01751-6 · Cited by 2
“Similarly, lower prescription rates of GLP-1RAs and SGLT2is have been observed among adults of non-white race or Hispanic ethnicity living with T2D compared with people who were white living with T2D in the US Veterans Health Administration system [23].”
Brady, V. J., Akyirem, S., & Padhye, N. S. (2025) · Primary care diabetes · doi:10.1016/j.pcd.2025.05.011 · Cited by 1
Management of Type 2 Diabetes Mellitus in Native Americans and Alaska Natives: A Systematic Review
Norris, Q., Brandt, M. D., Nagy, S. S., Kesselman, M. M., & Demory, M. L. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02668-3 · Cited by 1
Genie, M. G., & Ngorsuraches, S. (2025) · Value in Health · doi:10.1016/j.jval.2025.10.011 · Cited by 2
Andersson, T., Bager, J., Hellgren, M. I., Åberg, M., & Mourtzinis, G. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-110395 · Cited by 1
GLP-1RA Dispensing in Youth With Type 2 Diabetes: 2020 to 2023
Chu, P. Y., Kelly, A., Hennessy, S., Vajravelu, M. E., Huang, J., & Amaral, S. G. (2026) · PEDIATRICS · doi:10.1542/peds.2025-071971 · Cited by 2
Association of GLP-1 Receptor Agonist Use With Chronic Kidney Disease Risk in Type 2 Diabetes
Yen, F., Hsu, C., Hung, Y., Huang, J.-Y., Hwu, C., & Wei, J. C. (2026) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2026.01.035 · Cited by 1
German, J., Huang, W. A., Brucker, A., Daniel, K., Halpern, D. J., Bhavsar, N. A., Hinz, E. M., Shannon, R., Pignone, M. P., Crowley, M. J., et al. (2026) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2025-005546 · Cited by 1
Prescribing Trajectories in Type 2 Diabetes in the United States, 2019–2024
Lux, T. S., Lee, D., Phillips, J. M., Facelli, J. C., Malone, D. C., Wahl, M., Reddy, D., Sakaguchi, F. H., Gouripeddi, R., Millar, A. S., et al. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71013 · Cited by 1
The Vexing Problem of Persistent Disparities in Kidney Transplant Care
Mohottige, D., & Purnell, T. S. (2023) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.0000000000000097 · Cited by 1
Lussier, M. E., Gionfriddo, M. R., Graham, J., & Wright, E. A. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08435-6 · Cited by 1
“11 Second, other health care systems may not have as extensive of an ambulatory care pharmacy practice program and therefore the effect of the pharmacist might not be as robust.”
Metadata
- Authors
- Lamprea-Montealegre, J. A., Madden, E., Tummalapalli, S. L., Peralta, C., Neilands, T. B., Garcia, P. K., Muiru, A., Karliner, L., Shlipak, M. G., & Estrella, M. M.
- Affiliations
- University of California, San Francisco (US)
- Division of Nephrology, Department of Medicine, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia
- Corresponding author
- Lamprea-Montealegre, Julio A.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2022-09-06
- Volume
- 328
- Issue
- 9
- Pages
- 861
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC9449794
- OpenAlex
- W4294771462
- Cited by
- 129
- References
- 30
- Citations by year
- 2026: 19 · 2025: 47 · 2024: 37 · 2023: 23 · 2022: 2
- FWCI
- 20.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Repositorio Institucional (Pontificia Universidad Javeriana) (submittedVersion, cc-by-nc)
- Funders
- National Institute on Aging (K24AG067003, P30AG015272)
- National Heart, Lung, and Blood Institute (K99HL157721)
- National Institute of Mental Health (P30MH062246)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK119562)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, SGLT2 inhibitors, GLP-1 receptor agonists, racial disparities, ethnic disparities, prescription rates, veterans, health equity, Black veterans, Hispanic veterans, veterans' health care access, primary care visits, veterans' health care utilization, veterans' health care costs
- MeSH terms
- Health Equity, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Ethnicity, Female, Humans, Hypoglycemic Agents, Male, Practice Patterns, Physicians', Professional Practice, United States, Racial Groups, Healthcare Disparities, Prescriptions, Veterans Health
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