Racial and Ethnic Inequities in Diabetes Pharmacotherapy: Black and Hispanic Patients Are Less Likely to Receive SGLT2is and GLP1as
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Black, Hispanic/Latinx, and Asian individuals receive fewer prescriptions for SGLT2i or GLP1ra medications compared to White individuals.
“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 [17]
The Results report lower odds of receiving both SGLT2is and GLP1as for Black and Hispanic individuals compared with White individuals. The Discussion states that sample-size constraints precluded analyses of other racial or ethnic groups, so this paper does not support the claim about Asian individuals. Page numbers are not available in our copy. (LLM, conf=0.94)
Experimental — accuracy not yet measuredRecent studies have 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.
“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 [17]
The Results report that Black and Hispanic individuals had lower odds than White individuals of receiving both SGLT2is and GLP1as. The Discussion says sample-size constraints precluded analyses of other racial or ethnic groups, so this paper does not support the claim about Asian individuals. (LLM, conf=0.92)
Experimental — accuracy not yet measuredAnother potential explanation for why starkly different disparities by insurance type were observed includes structural racism embedded in health systems, and implicit or explicit bias among clinicians that may serve these different populations.
“Another potential explanation for why we observed starkly different disparities by insurance type includes structural racism embedded in health systems, and implicit or explicit bias among the clinicians that may serve these different populations.17,35–37”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [17]
The Discussion (page unavailable) implicates structural racism in racial inequities in diabetes medication use and suggests unequal coverage exacerbates them. It also lists interpersonal racism as a barrier, but does not specifically identify implicit or explicit clinician bias or establish that such bias explains differences by insurance type. (LLM, conf=0.85)
Experimental — accuracy not yet measuredBlack patients are significantly less likely than White patients to receive GLP-1 receptor agonists and SGLT2 inhibitors even when they meet clear clinical criteria.
“Analyses from large healthcare systems, including the Veterans Health Administration, show that Black patients are significantly less likely than White patients to receive these therapies [13].”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [13]
The Results report significantly lower adjusted odds of receiving both drug classes for Black patients than for White patients. But the Methods describe a nationally representative MEPS survey, not an analysis of a large healthcare system or the Veterans Health Administration. The Discussion also says the study lacked clinical metrics needed to determine whether some medications were contraindicated, so it cannot establish that patients met clear clinical criteria. (LLM, conf=0.88)
Experimental — accuracy not yet measuredInequities in diabetes management directly contribute to disparities in cardiovascular outcomes.
“Because type 2 diabetes is tightly linked to atherosclerotic cardiovascular disease, particularly coronary artery disease (CAD), inequities in diabetes management directly contribute to disparities in cardiovascular outcomes [13].”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [13]
The Background (page unavailable) says these medications can increase survival in patients with cardiac or renal disease, and the Results (page unavailable) find that Black and Hispanic patients were less likely to receive them. The paper does not assess cardiovascular outcomes or establish that treatment inequities directly cause disparities in those outcomes. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Type 2 diabetes is tightly linked to atherosclerotic cardiovascular disease, particularly coronary artery disease.
“Because type 2 diabetes is tightly linked to atherosclerotic cardiovascular disease, particularly coronary artery disease (CAD), inequities in diabetes management directly contribute to disparities in cardiovascular outcomes [13].”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [13]
The Background says that some patients receiving diabetes medications have comorbid cardiac disease, and the Methods analyze a subgroup with heart disease. Those passages establish that the conditions can coexist, but they do not establish a tight link between type 2 diabetes and atherosclerotic cardiovascular disease, particularly coronary artery disease. The Discussion also says the study could not distinguish type 1 from type 2 diabetes. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPrevious research has highlighted a pattern of treatment disparities that is consistent across various data sources.
“Previous research has highlighted a pattern of treatment disparities that is consistent across various data sources [12–17].”
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Cites
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“Because type 2 diabetes is tightly linked to atherosclerotic cardiovascular disease, particularly coronary artery disease (CAD), inequities in diabetes management directly contribute to disparities in cardiovascular outcomes [13].”
- Authors
- Cai, C., Woolhandler, S., McCormick, D., Himmelstein, D. U., Himmelstein, J., Schrier, E., & Dickman, S. L.
- Affiliations
- Brigham and Women's Hospital (US)
- Cambridge Health Alliance (US)
- University of California, San Francisco (US)
- Planned Parenthood (US)
- Corresponding author
- Cai, Christopher
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2022-02-09
- Volume
- 37
- Issue
- 13
- Pages
- 3501-3503
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC9551144
- OpenAlex
- W4210913682
- Cited by
- 14
- References
- 12
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 6 · 2023: 1 · 2022: 1
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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 Management and Research
- Keywords
- racial disparities, diabetes pharmacotherapy, SGLT2 inhibitors, GLP-1 receptor agonists, Black patients, Hispanic patients, prescription drug use, insulin, metformin, sulfonylureas, DPP-4 inhibitors, heart disease, chronic kidney disease, health insurance, health care utilization
- MeSH terms
- Black or African American, Diabetes Mellitus, Ethnicity, Hispanic or Latino, Humans, United States, Black People, Racial Groups
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