Black, Asian, female patients less likely to receive SGLT2 inhibitor prescription
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Black, Asian and female patients with type 2 diabetes are less likely to receive a prescription for an SGLT2 inhibitor compared with other groups, even when diagnosed with cardiovascular or kidney disease, a database analysis shows.
In an analysis of claims data from more than 900,000 patients with type 2 diabetes, researchers also found that patients with a median household income of less than $50,000 were similarly less likely to receive an SGLT2 inhibitor prescription.
“Among patients with diabetes in the U.S., Black race, female sex, and lower household income were associated with lower rates of SGLT2 inhibitor use, a medication with substantial cardioprotective and kidney protective benefits,” Lauren Eberly, MD, MPH, a cardiology fellow at the Perelman School of Medicine at the University of Pennsylvania, told Healio. “If left unaddressed, these inequities in utilization will continue to widen well-documented disparities in cardiovascular and kidney outcomes in the U.S.”
In a retrospective study, Eberly and colleagues analyzed data from 934,737 commercially insured patients in the U.S. with type 2 diabetes, using claims information from the Optum Clinformatics Data Mart from October 2015 to June 2019 (mean age, 65 years; 50.7% women; 57.6% white). The main outcome was prescription of an SGLT2 inhibitor. Researchers used logistic regression models to assess the association of race, sex and socioeconomic status with SGLT2 inhibitor use.
Within the cohort, 81,007 patients, or just 8.7%, were treated with an SGLT2 inhibitor during the study period.
Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and CVD or kidney disease, the rate of SGLT2 inhibitor use increased, but was lower than that among all patients with type 2 diabetes. The rate of SGLT2 inhibitor use increased from 1.9% to 7.6% for people with heart failure with reduced ejection fraction (HFrEF), from 3% to 9.8% for people with atherosclerotic CVD, and from 2.1% to 7.5% for people with chronic kidney disease.
In multivariable analyses, Black race was associated with lower rate of SGLT2 inhibitor use (adjusted OR = 0.83; 95% CI, 0.81-0.85), as was Asian race (aOR = 0.94; 95% CI, 0.9-0.98), and female sex (aOR = 0.84; 95% CI, 0.82-0.85).
In contrast, patients with a median household income of at least $100,000 were more likely to receive an SGLT2 inhibitor prescription (aOR = 1.08; 95% CI, 1.05-1.1) compared with those with a median household income of less than $50,000. These results were similar among patients with HFrEF, atherosclerotic CVD and CKD.
“These results are consistent with prior studies that have shown decreased use of novel therapies among Black patients. Implementation strategies that prioritize not only delivery of guideline-directed care, but also equitable guideline-directed care are critical in ensuring all patients have access to evidence-based therapies” Srinath Adusumalli, MD, MSHP, assistant professor of clinical medicine in the division of cardiovascular medicine at the University of Pennsylvania, said in a press release announcing the findings.
The study researchers found that having a visit with an endocrinologist in the last 12 months was one of the strongest factors associated with SGLT2 inhibitor use, acknowledging that the demonstrated clinical benefit may not be common knowledge yet for many nonspecialist providers treating patients with diabetes. Additionally, marginalized patient groups likely have barriers to accessing specialty care.
“We need to better understand and characterize the barriers to prescribing these agents,” Eberly told Healio. “We found that having a visit with an endocrinologist in the past 12 months was one of the strongest factors positively associated with SGLT2 inhibitor use; however, not every patient is able to access an endocrinologist for their diabetes care. Strategies to increase the comfort of all providers with prescribing SGLT2 inhibitor therapy will be essential to address inequitable use and ensure improved CV and kidney outcomes for all patients with type 2 diabetes. Also, it is important that out-of-pocket costs are minimized to make this therapy more broadly accessible.”
For more information:
Lauren Eberly, MD, MPH, can be reached at lauren.eberly@Pennmedicine.upenn.edu; Twitter: @eberly_lauren.
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