Racial and ethnic differences in pharmacy dispensing of sodiumglucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with type 2 diabetes
Recommended Citation
Rodriguez L, Finertie H, Neugebauer RS, Gosiker BJ, Thomas T, Karter AJ, Gilliam LK, Oshiro CE, An JX, Simonson GD, Cassidy-Bushrow AE, Dombrowski S, Nolan MB, O’Connor PJ, Schmittdiel J. Racial and ethnic differences in pharmacy dispensing of sodiumglucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with type 2 diabetes. Diabetologia 2024; 67:S203.
Document Type
Conference Proceeding
Publication Date
9-12-2024
Publication Title
Diabetologia
Keywords
cotransporter, glucagon like peptide 1, glucagon like peptide 1 receptor agonist, sodium glucose cotransporter 2 inhibitor, adult, Alaska Native, American Indian, Caucasian, cohort analysis, conference abstract, drug therapy, electronic health record, ethnic difference, ethnic group, ethnicity, female, Hispanic, human, major clinical study, male, middle aged, non insulin dependent diabetes mellitus, Pacific Islander, retrospective study, United States
Abstract
Background and aims: Treatment with Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) or Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) reduce adverse cardiorenal outcomes in patients with type 2 diabetes (T2D). Our objective was to evaluate pharmacy dispensing of SGLT2i and GLP1-RA among patients with T2D over time and by race and ethnicity. Materials and methods: This was a retrospective cohort study of patients (age≥18 years) with T2D using 2014-2022 electronic health record data from six large US care delivery systems that are part of the health care systems research network. Cohort entry was at earliest pharmacy dispensing of any T2D medication. We used logistic regression to evaluate the association between pharmacy dispensing of SGLT2i and GLP1-RA and race and ethnicity, adjusting for cardiovascular risk factors and clinical and demographic characteristics at baseline. We also evaluated annual trends in pharmacy dispensing using logistic regression with an interaction term between race and ethnicity and dispensing year, adjusting for age, sex, and site. We output annual predicted rates for SGLT2i and GLP1-RA by race and ethnicity. Results: Our cohort included 687,165 patients (median age 60 [interquartile range 51, 69]; 47% female; 0.3% American Indian or Alaska Native (AI/AN), 16.6% Asian, 10.5% Black, 1.4% Hawaiian or Pacific Islander (HPI), 31% Hispanic, 3.8% Other, and 36.4% White). Patients were followed for a median of 6 years. The rate of annual pharmacy dispensing of SGLT2i increased from 0.1% to 12.2% between 2014 and 2022 and increased from 0.3% to 3.8% for GLP1-RA between 2014 and 2022. In adjusted models, SGLT2i dispensing was lower for AI/AN (OR 0.80, 95% CI 0.68-0.94), Black (OR 0.89, 0.86-0.92) and Hispanic (OR 0.87, 0.85-0.89), but higher for Asian patients (OR 1.11, 1.08-1.14), compared to White adults. GLP1-RA dispensing was lower for AI/AN (OR 0.78, 0.63-0.97), Asian (OR 0.50, 0.48-0.53), Black (OR 0.86, 0.83-0.90), HPI (OR 0.52, 0.46-0.57), Hispanic (OR 0.69, 0.66-0.71), and Other (OR 0.78, 0.73-0.83) compared to White adults. Conclusion: Pharmacy dispensing of SGLT2i and GLP1-RA medications was lower in patients with T2D from most minority groups compared to White adults in six large US care delivery systems. This suggests the need to evaluate approaches to increase use of these cardiorenal protective drugs in patients from racial and ethnic minority groups with T2D to reduce adverse cardiorenal outcomes and improve health equity.
Volume
67
First Page
S203
