Disparities in adoption of new diabetic therapies with cardiovascular benefits
Open accessAbstract
Aims Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) have cardiovascular benefit, but adoption into clinical practice has been lagging. We aim to evaluate use of SGLT2i and GLP1a across socioeconomic strata (SES), medical risk as well as provider type.Methods We conducted a retrospective cohort study of the prescription of SGLT2i or GLP1a within 12 months of clinic visit between January 1, 2018 and January 1, 2019 using de-identified claims data. The primary outcome was the composite of a medication fill of either an SGLT2i and/or GLP1a within 180 days of the index visit.Results Of the total cohort, 125,636 (15.8 %) received either a GLP-1a or SGLT2i.The odds of prescription of either medication was 0.64 [p = 0.006)] in patients with heart failure. Patients who identified as Black, Hispanic or Asian had lower odds of the primary outcome [Black: (AOR 0.81, p < 0.000); Hispanic: (AOR 0.87, p < 0.000); Asian: (AOR 0.83, p < 0.000). The odds was higher for those treated by an endocrinologist versus primary care clinician [AOR 2.12, p < 0.000)].Conclusions Prescriptionof SGLT2i or GLP1a was lower among patients with cardiovascular co-morbidities and those who identified as Black, Hispanic or Asian. Further efforts to minimize these disparities should be pursued.
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Cost alone does not fully explain unequal prescribing of GLP-1 receptor agonists and SGLT2 inhibitors, because disparities persist even within integrated healthcare systems that reduce financial barriers.
“Notably, these disparities persist even within integrated healthcare systems that reduce financial barriers, suggesting that cost alone does not fully explain unequal prescribing [17].”
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 [17]
The Results and Discussion report disparities in GLP-1RA/SGLT2i treatment within clinician practices and identify possible contributors beyond patients’ actual costs. But the study used a commercially insured cohort, not an integrated healthcare system shown to reduce financial barriers; its Discussion also describes unaffordability as a critical factor. No page numbers are provided in our copy. (LLM, conf=0.87)
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Flagged first, then by citations
3 of the 41 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [11]American Diabetes Association, Standards of Medical Care in Diabetes – 2018. Diabetes Care. 2018; 41(1): S1– S156.29222369
Cited by
Sorted by citations
Socioeconomic aspects of incretin-based therapy
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“Vasti 2023 [25] 793,525 • Education • Low education linked to lower GLP-1 RA usage (OR vs higher education, 0.”
BackgroundInfluentialEarly combination therapy with SGLT2i and GLP ‐1 RA or dual GIP / GLP ‐1 RA in type 2 diabetes
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“Notably, these disparities persist even within integrated healthcare systems that reduce financial barriers, suggesting that cost alone does not fully explain unequal prescribing [17].”
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“Similar disparities have been reported among Medicaid beneficiaries, women, older adults, rural populations, and individuals living in socioeconomically disadvantaged communities [10, 11, 15, 21, 22].”
Influential
- Authors
- Vasti, E. C., Basina, M., Calma, J., Maron, D. J., Rodriguez, F., & Sandhu, A. T.
- Affiliations
- Stanford Medicine (US)
- Stanford University (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Vasti, Elena C.
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 196
- Pages
- 110233
- ISSN
- 0168-8227 (ISSN-L)
- PMC
- PMC10234597
- OpenAlex
- W4312221549
- Cited by
- 11
- References
- 41
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 4
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 356 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- Diabetes Research and Clinical Practice (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- SGLT2 inhibitors, GLP-1 receptor agonists, antidiabetic drugs, cardiovascular benefits, racial and ethnic disparities, socioeconomic disparities, heart failure, primary care prescribing
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Sodium-Glucose Transporter 2 Inhibitors, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Heart Failure, Humans, Hypoglycemic Agents, Retrospective Studies
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