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
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Date
2022-09-06Authors
Lamprea-Montealegre, Julio A.Madden, Erin
Tummalapalli, Sri Lekha
Peralta, Carmen
Neilands, Torsten B.
García Padilla, Paola Karina
Muiru, Anthony
Karliner, Leah
Shlipak, Michael G.
Estrella, Michelle M.
Corporate Author(s)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Medicina Interna. Nefrología
Type
Artículo de revista
ISSN
0098-7484 / 1538-3598 (Electrónico)
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Abstract
Importance: Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents’ prescription across racial and ethnic groups has not been well-evaluated.
Objective : To investigate differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups.
Design, Setting, and Participants: Cross-sectional analysis of data from the US Veterans Health Administration’s Corporate Data Warehouse. The sample included adult patients with type 2 diabetes and at least 2 primary care clinic visits from January 1, 2019, to December 31, 2020.
Exposures Self-identified race and self-identified ethnicity: Main Outcomes and Measures The primary outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active prescription during the study period.
Results: Among 1 197 914 patients (mean age, 68 years; 96% men; 1% American Indian or Alaska Native, 2% Asian, Native Hawaiian, or Other Pacific Islander, 20% Black or African American, 71% White, and 7% of Hispanic or Latino ethnicity), 10.7% and 7.7% were prescribed an SGLT2i or a 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. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 7.1% among Hispanic or Latino patients and 10.7% and 7.8% among non-Hispanic or Latino patients. After accounting for patient- and system-level factors, all racial groups had significantly lower odds of SGLT2i and GLP-1 RA prescription compared with White patients. Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio, 0.72 [95% CI, 0.71-0.74] for SGLT2i and 0.64 [95% CI, 0.63-0.66] for GLP-1 RA). Patients of Hispanic or Latino ethnicity had significantly lower odds of prescription (0.90 [95% CI, 0.88-0.93] for SGLT2i and 0.88 [95% CI, 0.85-0.91] for GLP-1 RA) compared with non-Hispanic or Latino patients.
Conclusions and Relevance: Among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.
Temporary coverage
2019-2020Community
Pacientes con Diabetes tipo 2Link to the resource
https://jamanetwork.com/journals/jama/fullarticle/2795891Source
JAMA - Journal of the American Medical Association; Volumen 328 Número 9 , Páginas 861 - 871 (2022)
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