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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].”
Citations
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Khan, S. S., Breathett, K., Braun, L. T., Chow, S. L., Gupta, D. K., Lekavich, C., Lloyd-Jones, D. M., Ndumele, C. E., Rodriguez, C. J., Allen, L. A., et al. (2025) · Circulation · doi:10.1161/cir.0000000000001307 · Cited by 75
“162,163 Whereas SGLT2is have been heralded as the “statins” of HF prevention, 164 at current pricing, cost-effectiveness analyses of SGLT2i declare them to be of “moderate economic value” even in prevalent HFrEF (a cost–value statement was included in the 2022 Heart Failure Guidelines).”
Essien, U. R., Singh, B., Swabe, G., Johnson, A. E., Eberly, L. A., Wadhera, R. K., Breathett, K., Vaduganathan, M., & Magnani, J. W. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.16290 · Cited by 69
Forbes, A., Hinton, W., Feher, M. D., Elson, W. H. D., Joy, M., Ordóñez-Mena, J. M., Fan, X., Cole, N. I., Banerjee, D., Suckling, R., et al. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102426 · Cited by 57
Gregg, L. P., Ramsey, D. J., Akeroyd, J. M., Jafry, S. A., Matheny, M. E., Virani, S. S., & Navaneethan, S. D. (2023) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2022.11.017 · Cited by 45
Agyemang, C. O., van der Linden, E. L., Chilunga, F. P., & van den Born, B. H. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.030228 · Cited by 50
“144 Whether the failure to involve non–European-descent populations in research is related to decreased prescription of novel medications as a result of lack of evidence remains to be established, but the observation that novel therapies are not being examined and prescribed to those that will…”
Background
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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