Low Use of GLP-1 RAs Observed in Treatment of Type 2 Diabetes

Lauren A. Eberly, MD, MPH

Although there are noted disparities in diabetes prevalence, with Black and Hispanic patients having a disproportionate burden of type 2 diabetes (T2D), beneficial cardiovascular therapeutics are often underused in treatment of these patient populations.

Accordingly, a recent study evaluated the uptake of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in a commercially insured population of patients with T2D, identified associations of race, ethnicity, sex, and socioeconomic status with GLP-1 RA use, and examined use in a subgroup of patients with established atherosclerotic cardiovascular disease (ASCVD).

Led by Lauren A. Eberly, MD, MPH, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, investigators observed the use of the agent increased, but remained low overall in the treatment of T2D, finding Asian, Black, and Hispanic patients and those with lower income were less likely to receive treatment with an agent.

Data in the retrospective cohort analysis were obtained from the OptumInsight Clinformatics Data Mart database (Optum Inc). The database consisted of inpatient, outpatient, and pharmacy claims from more than 17 million patients annually from all 50 states in the United States.

It collected demographic information including age, sex, and race and ethnicity, with the available categories of Asian, Black, Hispanic ethnicity, White, and other/unknown. Additionally, socioeconomic data such as median household income were available through zip code-linked enrollment data from the US Census Bureau.

Investigators identified adult patients (≥18 years) with a diagnosis of T2D from October 2015 - December 2018. The primary outcome of interest was considered 1 prescription for a GLP-1 RA filled at any point during the study period for each individual.

Then, they estimated multivariable logistic regression models to identify the association of race, ethnicity, sex, and socioeconomic status with GLP-1 RA use.

Out of a total of 1,180,260 patients with T2D, 90,934 (7.7%) were treated with a GLP-1 RA during the study period. Data show the patient population consisted of 594,088 female patients (50.3%), 681, 579 (57.7%) White, and had a median age of 69 years.

During the study period, the percentage of patients with diabetes treated with a GLP-1 RA increased from 3.2% in 2015 to 10.7% in 2019. In patients who also had ASCVD (n = 815,309), GLP-1 RA use increased from 2.8% to 9.4%.

In multivariable analyses, lower rates of GLP-1 RA use were found among Asian (adjusted odds ratio OR, 0.59; 95% CI, 0.56 - 0.62), Black (aOR, 0.81; 95% CI, 0.79 - 0.83), and Hispanic (aOR, 0.91; 95% CI, 0.88 - 0.93) patients with T2D.

On the other hand, 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) were associated with higher GLP-1 RA use. Results were found to be similar in patients with ASCVD.

Eberly and colleagues noted the study is the first to demonstrate notable racial, ethnic, and socioeconomic inequities in GLP-RA use, despite the population being 100% commercially insured.

“Implementation of strategies to ensure more equitable use of GLP-1 RA therapy is warranted,” investigators wrote.

The study, “Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US,” was published in JAMA Health Forum.