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Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US
Open accessAbstract
Importance: Randomized clinical trials have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) cause significant weight loss and reduce cardiovascular events in patients with type 2 diabetes (T2D). Black patients have a disproportionate burden of obesity and cardiovascular disease and have a higher rate of cardiovascular-related mortality. Racial and ethnic disparities in health outcomes are largely attributable to the pervasiveness of structural racism, and patients who are marginalized by racism have less access to novel therapeutics. Objectives: To evaluate GLP-1 RA uptake among a commercially insured population of patients with T2D; identify associations of race, ethnicity, sex, and socioeconomic status with GLP-1 RA use; and specifically examine its use among the subgroup of patients with atherosclerotic cardiovascular disease (ASCVD) because of the known benefit of GLP-1 RA use for this population. Design Setting and Participants: This was a retrospective cohort analysis using data from OptumInsight Clinformatics Data Mart of commercially insured adult patients with T2D (with or without ASCVD) in the US. Data from October 1, 2015, to June 31, 2019, were included, and the analyses were performed in July 2020. We estimated multivariable logistic regression models to identify the association of race, ethnicity, sex, and socioeconomic status with GLP-1 RA use. Main Outcome and Measure: A prescription for a GLP-1 RA. Results: Of the 1 180 260 patients with T2D (median [IQR] age, 69 [59-76] years; 50.3% female; 57.7% White), 90 934 (7.7%) were treated with GLP-1 RA during the study period. From 2015 to 2019, the percentage of T2D patients treated with an GLP-1 RA increased from 3.2% to 10.7%. Among patients with T2D and ASCVD, use also increased but remained low (2.8%-9.4%). In multivariable analyses, lower rates of GLP-1 RA use were found among Asian (aOR, 0.59; 95% CI, 0.56-0.62), Black (adjusted odds ratio [aOR] 0.81; 95% CI, 0.79-0.83), and Hispanic (aOR, 0.91; 95% CI, 0.88-0.93) patients with T2D. Female sex (aOR, 1.22; 95% CI, 1.20-1.24) and higher zip code-linked median household incomes (>$100 000 [OR, 1.13; 95% CI, 1.11-1.16] and $50 000-$99 999 [OR, 1.07; 95% CI, 1.05-1.09] vs <$50 000) were associated with higher GLP-1 RA use. These results were similar to those found among patients with ASCVD. Conclusions and Relevance: In this cohort study of US patients with T2D, GLP-1 RA use increased, but remained low overall for treatment of T2D, particularly among patients with ASCVD who are likely to derive the most benefit. Asian, Black, and Hispanic patients and those with low income were less likely to receive treatment with a GLP-1 RA. Strategies to lower barriers to GLP-1 RA use, such as lower cost, are needed to prevent the widening of well-documented inequities in cardiovascular disease outcomes in the US.
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“In a study of ~1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP‐1 use was seen among Asian, Black, and Hispanic, compared with White, individuals and among those living in lower versus higher income households [237].”
From Nutritional priorities to support GLP ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [237]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“One study demonstrated that of those medically eligible for this treatment, Asian, Black, Hispanic, and low-income patients are less likely to be treated with a GLP-1RAs.38”
From The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy (2025) · cites this paper as [38]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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 [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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 [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Previous research has highlighted a pattern of treatment disparities that is consistent across various data sources [12–17].”
From 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 (2025) · cites this paper as [13]
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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 [15]
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In the citing paper
“Although data on SGLT2i and GLP-1RA disparities in older Medicare patients with type 2 diabetes and comorbid HF, ASCVD and CKD are lacking, our findings generally align with existing literature on the diffusion of newer glucose-lowering therapies and racial and ethnic disparities [11–13, 16, 29].”
In the citing paper
“In a study of ∼1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP-1 use was seen among Asian, Black, and Hispanic, compared with White, individuals and among those living in lower versus higher income households [229].”
In the citing paper
“In a study of ∼1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP-1 use was seen among Asian, Black, and Hispanic, compared with White, individuals and among those living in lower versus higher income households [237].”
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Citations
Cites
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Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
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How Structural Racism Works — Racist Policies as a Root Cause of U.S. Racial Health Inequities
Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021) · New England Journal of Medicine · doi:10.1056/nejmms2025396 · Cited by 1,598
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Research works printed but not linked: 1
- Institute of Medicine, 2003, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
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Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association
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“In a study of ~1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP-1 use was seen among Asian, Black, and Hispanic, compared with White, individuals and among those living in lower versus higher income households [229].”
InfluentialLamprea-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. (2022) · JAMA · doi:10.1001/jama.2022.13885 · Cited by 129
Metadata
- Authors
- Eberly, L. A., Yang, L., Essien, U. R., Eneanya, N. D., Julien, H. M., Luo, J., Nathan, A. S., Khatana, S. A. M., Dayoub, E. J., Fanaroff, A. C., Giri, J., Groeneveld, P. W., & Adusumalli, S.
- Affiliations
- Leonard Davis Institute of Health Economics (US)
- University of Pennsylvania (US)
- University of Pittsburgh (US)
- VA Pittsburgh Healthcare System (US)
- Philadelphia VA Medical Center (US)
- Corresponding author
- Eberly, Lauren A.
- ORCID
- Venue
- JAMA Health Forum
- Publisher
- American Medical Association (AMA)
- Published
- 2021-12-17
- Volume
- 2
- Issue
- 12
- Pages
- e214182
- ISSN
- 2689-0186 (ISSN-L)
- PMC
- PMC8796881
- OpenAlex
- W4200521668
- Cited by
- 288
- References
- 39
- Citations by year
- 2026: 60 · 2025: 114 · 2024: 71 · 2023: 31 · 2022: 11
- FWCI
- 21.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- JAMA Health Forum (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL153772)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK120956)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- GLP-1 receptor agonists, type 2 diabetes, racial and ethnic disparities, socioeconomic status, atherosclerotic cardiovascular disease, Black patients, Asian patients, prescription drug use, structural racism, commercially insured patients, sex differences, treatment disparities, cardiovascular risk reduction, weight loss, United States
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Ethnicity, Female, Humans, Male, Retrospective Studies, Socioeconomic Factors, Cohort Studies, Glucagon-Like Peptide 1
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