Prescriptions of SGLT2i, GLP-1 RA Low in T2D Care Among Racial, Ethnic Groups

Julio A. Lamprea-Montealegre, MD, MPH, PhD

Low prescription rates of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) were observed among patients with type 2 diabetes (T2D) in the Veterans Health Administration system, according to new findings.

Individuals who belonged to various racial groups as well as those of Hispanic ethnicity were reported as having statistically significantly lower odds of receiving prescriptions when compared with individuals of White race and non-Hispanic ethnicity.

“The observed lower prescription of SGLT2i and GLP-1 RA for all race and ethnic groups relative to White patients and non-Hispanic patients persisted even after accounting for a broad array of patient- and system-level characteristics,” wrote study author Julio A. Lamprea-Montealegre, MD, MPH, PhD, University of California, San Francisco.

The use of these therapies to lower the risk of cardiovascular disease and chronic kidney disease (CKD) progression remains a strong recommendation in current guidelines. However, often, racial and ethnic minority individuals are less likely than their White counterparts to be prescribed these therapies.

In order to better understand the equitability of prescriptions across racial and ethnic groups, Lamprea-Montealegre and colleagues performed a cross sectional analysis of data from the VHA Corporate Data Warehouse. They ascertained diagnosis of diabetes and included all patients with T2D who had ≥2 primary care encounters between January 2019 and December 2020.

Race and ethnicity at each VHA station were collected through a 2-question self-identified method included at time of application or at time of visit to a facility. Then, across each race and ethnicity category, investigators assessed the prevalence of SGLT2i and GLP-1 RA prescription during the study period.

After matching inclusion criteria, the study sample consisted of 1,197,914 patients with T2D with a mean age of 68 years and 96% men. The race and ethnicity categories were noted as 1% American Indian or Alaska Native; 2% Asian, Native Hawaiian, or Other Pacific Islander; 20% Black; 71% White; and 7% of Hispanic ethnicity.

In this population, 10.7% and 7.7% were prescribed an SGLT2i or GLP-1 RA, respectively.

Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 8.4% among American Indian or Alaska Native patients; 11.8% and 8% among Asian, Native Hawaiian, or Other Pacific Islander patients; 8.8% and 6.1% among Black or African American patients; and 11.3% and 8.2% among White patients, respectively.

Among Hispanic patients, prescription rates for SGLT2i and GLP-1 RA were 11% and 7.1%, respectively, compared to 10.7% and 7.8% among non-Hispanic or Latino patients.

All racial groups were observed to have statistically significant lower odds and absolute risk difference of SGLT2i and GLP-1 RA prescription, compared with White individuals, after adjustment for patient- and system-level factors.

Investigators noted that Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio [OR], 0.72; 95% confidence interval [CI}, 0.71 - 0.74 - SGLT2i and 0.64; 95% CI, 0.63 - 0.66 for GLP-1 RA).

When compared with non-Hispanic ethnicity, the odds of prescription among Hispanic patients were 0.90 (95% CI, 0.88 - 0.93) for SGLT2i and 0.88 (95% CI, 0.85 - 0.91) for GLP-1 RA.

Lamprea-Montealegre noted that the low prescription rates of these therapies across ethnic groups may be due to their novel nature, but the existence of implicit bias may still play a role.

“As quality improvement initiatives are established to overcome this treatment gap, these findings suggest that such initiatives must take a racial and ethnic equity lens so that improvements in care can extend benefits to all,” he added.

The study, “Association of Race and Ethnicity with Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients with Type 2 Diabetes in the Veterans Health Administration System,” was published in JAMA.