Deficits and Disparities in Early Uptake of Glucagon-Like Peptide 1 Receptor Agonists and SGLT2i Among Medicare-Insured Adults Following a New Diagnosis of Cardiovascular Disease or Heart Failure

Collectively, the findings underscore a consistent gap between evidence-based recommendations and real-world practice, particularly among patients with multiple chronic conditions who stand to benefit most from GLP-1 receptor agonists and SGLT2 inhibitors.

“Collectively, these findings underscore a consistent gap between evidence-based recommendations and real-world practice, particularly among patients with multiple chronic conditions who stand to benefit most from these therapies [2,33].”

Prior studies of racial and ethnic disparities in SGLT2i and GLP-1 RA use included few younger patients or women.

“or few younger patients or women,6,8,9”

Prior studies of racial and ethnic disparities in SGLT2i and GLP-1 RA use used administrative or insurance claims-based databases, which lacked important clinical variables such as glycemic control and diabetes duration.

“These studies, however, had limitations: cohorts did not extend beyond 20195, 6, 7,10,11 or 2020,8,9 used administrative or insurance claims-based databases,5, 6, 7,10,11 included few racially and ethnically diverse groups,5,8 or few younger patients or women,6,8,9 sample sizes were small,8 and important clinical variables such as glycemic control5, 6, 7,11 and diabetes duration5, 6, 7, 8, 9,11”

Our findings generally align with existing literature on the diffusion of newer glucose-lowering therapies and racial and ethnic disparities.

“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].”

Recent studies have shown racial and ethnic disparities in the use of SGLT2i and GLP-1 RA.

“Recent studies have shown racial and ethnic disparities in the use of these medications.5, 6, 7, 8, 9, 10”

Prior studies of racial and ethnic disparities in SGLT2i and GLP-1 RA use had cohorts that did not extend beyond 2019 or 2020.

“These studies, however, had limitations: cohorts did not extend beyond 20195, 6, 7,10,11 or 2020,8,9 used administrative or insurance claims-based databases,5, 6, 7,10,11 included few racially and ethnically diverse groups,5,8 or few younger patients or women,6,8,9 sample sizes were small,8 and important clinical variables such as glycemic control5, 6, 7,11 and diabetes duration5, 6, 7, 8, 9,11”

Our work supports prior findings.

“Our work supports prior findings5,6 and highlights the need to evaluate approaches to increase the use of these cardiorenal protective drugs in patients from racial and ethnic minority groups with type 2 diabetes to reduce adverse cardiorenal outcomes and improve health equity.”