Inequities in access to SGLT2 inhibitor therapy uncovered
medwireNews: Results from a US retrospective study suggest that usage rates of sodium-glucose cotransporter (SGLT)2 inhibitors remain low in people with type 2 diabetes, particularly among Black and Asian individuals, women, and lower-income groups.
For the study, the team used the Optum Clinformatics Data Mart database, including information from 934,737 adults with type 2 diabetes (mean age 65.4 years, 50.7% female, 57.6% White) between 2015 and 2019. While the overall proportion of people treated with SGLT2 inhibitors increased during the study period, from 3.8% to 11.9%, overall use remained low, say the researchers in JAMA Network Open.
Similarly, SGLT2 inhibitor usage rates remained low among patients with comorbid heart failure with reduced ejection fraction (HFrEF; n=26,054), atherosclerotic cardiovascular disease (ASCVD; n=594,058), or chronic kidney disease (CKD; n=92,485) despite an increase from 1.9 to 7.6%, 3.0 to 9.8%, and 2.1 to 7.5%, respectively.
In a multivariable analysis, Black and Asian people had lower rates of SGLT2 inhibitor use compared with White people, with adjusted odds ratios (aORs) of 0.83 and 0.94, respectively, and women were less likely to use SGLT2 inhibitors than men, with an aOR of 0.84.
The results also showed that having a median household income of US$ 50,000–99,999 (€ 41,427–82,853) or at least $ 100,000 (€ 82,854) was associated with higher rates of SGLT2 inhibitor use, with aORs of 1.05 and 1.08, respectively, compared with a median income below $ 50,000.
Other factors independently associated with a reduced rate of SGLT2 inhibitor use were HFrEF and HF with preserved ejection fraction, with aORs of 0.85 and 0.83, respectively. CKD was not associated with the likelihood of using an SGLT2 inhibitor, however.
The researchers note that “having a visit with an endocrinologist in the last 12 months was one of the strongest factors positively associated with SGLT2 inhibitor use,” with an aOR of 2.06, suggesting that the demonstrated clinical benefit of these agents “may not yet be common knowledge yet among many nonspecialist providers who treat patients with diabetes.”
Lauren Eberly, from the University of Pennsylvania, Philadelphia, USA, and fellow co-authors report that these results remained consistent in all subgroup analyses.
“These findings suggest that racial, gender, and socioeconomic inequities are present in access to SGLT2 inhibitor treatment,” say Eberly et al.
They conclude that if left unaddressed, these inequities “may widen disparities in kidney and cardiovascular outcomes in the US.”
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