Disparities identified in STGLT2 inhibitor use among Medicare-insured patients with CKD
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Black and older patients with chronic kidney disease and insured by Medicare are less likely to start SGLT2 inhibitors or glucagon-like peptide 1 receptor agonists than second-generation sulfonylureas, according to data in Kidney Medicine.
“There is limited information examining the use of SGLT2i or [glucagon-like peptide 1 receptor agonists] GLP-1RA among patients with CKD with type 2 diabetes in the Medicare population perspective across different age, sex, race/ethnicity or socioeconomic groups,” Julie Z. Zhao, MPH, PhD, from the department of pharmaceutical care and health systems in the college of pharmacy at the University of Minnesota, and colleagues wrote. “Our study aimed to examine whether patients with CKD and type 2 diabetes were more likely to start SGLT2i and GLP-1RA, compared with the second-generation sulfonylureas in a more recent Medicare Fee-For-Service population.”
In a retrospective cohort study, researchers examined data of a 20% random sample of Medicare Fee-For-Service claims which included 53,029 adults with CKD and type 2 diabetes between 2013 and 2018. With the use of STGLT2i, GLP-1RA or sulfonylureas serving as primary outcomes of the study, researchers considered patients’ sociodemographic and clinical factors as exposures. After determining patients with a newly initiated prescription of SGLT2i, GLP-1RA or second-generation sulfonylureas, researchers conducted multinomial logistic regression models to assess demographic and clinical factors correlated with the initiation.
Overall, 10% of patients had a first prescription for SGLT2i, 17.4% for GLP-1RA and 72.6% for sulfonylurea. Patients aged 75 years or older were less likely than those aged 65 to 74 years to start SGLT2i or GLP-1RRA instead of sulfonylureas. Further, Black patients were less likely to start SGLT2i or GLP-1RA than white patients. Researchers also observed lower odds of GLP-1RA initiation among Hispanic and Asian patients.
Additionally, analyses revealed that patients with cardiovascular disease or hyperlipidemia were more likely to start SGLT2i or GLP-1RA. Compared with men, women were more likely to start GLP-1RA than SGLT2i.
“Of particular concern, Black patients were significantly less likely to be initiated on SGLT2i or GLP-1RA and were more likely to receive sulfonylureas, which have not showed cardiovascular or kidney benefits and are more likely to cause hypoglycemia. This represents a health disparity and a pharmaco-equity issue that needs to be addressed to slow kidney disease progression in a population that is at higher risk of progressing to kidney failure,” Zhao and colleagues wrote. They added, “These findings should also be a call for public education and political action by kidney disease patient advocacy organizations, such as the National Kidney Foundation, American Society of Nephrology, and American Association of Kidney Patients, to eliminate health disparities in the prescription of newer diabetes agents that have been shown to slow the rate of CKD progression.”
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