20 Dec Diabetes: Racial, Ethnic, and Socioeconomic Inequities in GLP-1 RA Drug Use
MedicalResearch.com Interview with:
Lauren A. Eberly, MD, MPH
Clinical Fellow, Cardiovascular Medicine
Perelman School of Medicine
Cardiovascular Division, Perelman School of Medicine
Center for Cardiovascular Outcomes, Quality, and Evaluative Research,
Cardiovascular Center for Health Equity and Social Justice,
Leonard Davis Institute of Health Economics
University of Pennsylvania, Philadelphia
MedicalResearch.com: What is the background for this study?
Response: Racial inequities are pervasive in our country, and cardiovascular therapeutics with proven benefit have been shown to be underutilized among Black and Latinx patients.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a recommended treatment option for glycemic control in patients with diabetes, have recently emerged as a cardioprotective therapy as multiple large randomized clinical trials have shown they prevent cardiovascular events among patients with Type 2 Diabetes (T2D), particularly patients with established atherosclerotic cardiovascular disease (ASCVD). Given this, they are now recommended therapy for patients with diabetes and established or high risk of ASCVD.
Given the known inequitable utilization of other therapies, along with the known higher burden of diabetes and cardiovascular disease among Black patients, the aim of this study was to evaluate the uptake of GLP-1 RA as well as for inequities in utilization.
MedicalResearch.com: What are the main findings?
Response: We found that since 2019, the percentage of Type 2 Diabetic patients treated with an GLP-1 RA increased from 3.2% to 10.7%. Among patients with T2D and ASCVD, use also increased but remained low (2.8%-9.4%). In multivariable analyses, lower rates of GLP-1 RA use were found among Asian (aOR, 0.59; 95% CI, 0.56-0.62), Black (adjusted odds ratio [aOR] 0.81; 95% CI, 0.79-0.83), and Hispanic (aOR, 0.91; 95% CI, 0.88-0.93) patients with T2D. 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] vs <$50 000) were associated with higher GLP-1 RA use. These results were similar to those found among patients with ASCVD.
MedicalResearch.com: What should readers take away from your report?
Response: In this study, we found low use of GLP-1 RAs, including among patients with T2D and ASCVD. Despite that 100% of this population was commercially insured, this is the first study, to our knowledge, to demonstrate notable racial, ethnic, and socioeconomic inequities in GLP-1 RA use. Asian, Black, and Hispanic individuals had lower use of GLP-1 RA, while higher household income was independently associated with higher use. Strategies to address inequitable uptake, including increasing affordability of these medications, must be addressed to prevent the widening of racial and ethnic disparities in cardiovascular disease and outcomes in the US. Often, socioeconomic status and lack of health insurance are blamed for racial and ethnic inequities in health care and health outcomes. However, the racial and ethnic disparities in GLP-1 RA use demonstrated by our study persisted after adjustment not only for clinical factors, but also for engagement with specialty care and socioeconomic status, and were in the setting of a 100% commercially insured population.
Therefore, these results reveal biases in health care delivery that must be rectified. These results reflect the pervasive inequity of the US health care system for patients who are not White.
Eberly LA, Yang L, Essien UR, et al. Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US. JAMA Health Forum. 2021;2(12):e214182. doi:10.1001/jamahealthforum.2021.4182
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