ArticleDiabetologia2025
Racial and ethnic disparities in the uptake of SGLT2is and GLP-1RAs among Medicare beneficiaries with type 2 diabetes and heart failure, atherosclerotic cardiovascular disease and chronic kidney disease, 2013-2019.
Article in Diabetologia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Disparities in GLP-1RA and SGLT2i Uptake: a Systematic Review and an Equity-First Framework for Cardiovascular-Kidney-Metabolic Care.Current cardiology reports · 2026Pooled it
- Real-world prescribing patterns of SGLT2 inhibitors and GLP-1 receptor agonists in Type 2 diabetes with various ASCVD subtypes from a large tertiary referral center.American journal of preventive cardiology · 2026Article
- Trends in Second-Line Initiations and Treatment Outcomes Across Age and Frailty Groups in People With Type 2 Diabetes: UK Population-Based Study, 2019-2024.Diabetes, obesity & metabolism · 2026Article
- Combination cardiometabolic therapy in type 2 diabetes: optimizing SGLT2 inhibitor and GLP‑1 receptor agonist use.Current atherosclerosis reports · 2026Review
- Tailoring interventions to close gaps in diabetes mellitus care.Nature reviews. Endocrinology · 2026Review
- Review
- Racial and ethnic disparities in the management of risk factors in individuals with atrial fibrillation: A narrative review.American journal of preventive cardiology · 2026Review
- Current Insights and Future Directions on the Role of GLP-1 Receptor Agonists in Chronic Kidney Disease.International journal of nephrology and renovascular disease · 2026Review
- Effect of Semaglutide Combined With Conventional Insulin Therapy on Blood Glucose Control and Renal Function in Elderly Patients With Type 2 Diabetes.International journal of endocrinology · 2026Article
- Overcoming Disparities in Using SGLT2 Inhibitors for Cardiorenal Protection in Persons With and Without Type 2 Diabetes.The Journal of clinical endocrinology and metabolism · 2025Review
- Evaluation of a management platform for extended care of type 2 diabetes.Diabetology & metabolic syndrome · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
aims/hypothesisThe aim of this study was to investigate racial and ethnic disparities in the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor antagonists (GLP-1RAs) among older adults with type 2 diabetes and cardiorenal conditions.
methodsUsing Medicare fee-for-service data (2013-2019), this retrospective cohort study identified older adults (≥65 years) with type 2 diabetes initiating second-line therapies (SGLT2is, GLP1-RAs, dipeptidyl peptidase-4 inhibitors [DPP4is] and sulfonylureas [SUs]) with (1) heart failure (HF), (2) atherosclerotic cardiovascular disease (ASCVD), (3) chronic kidney disease (CKD) and (4) no recorded cardiorenal conditions. Participants were classified as non-Hispanic White, non-Hispanic Black and Hispanic. Multinomial regressions, adjusting for sociodemographic, clinical and county-level characteristics, were used to model the odds of initiating SGLT2is or GLP-1RAs within each cohort.
resultsBlack participants with HF, ASCVD, CKD or no recorded cardiorenal conditions had 35% (adjusted OR 0.65 [95% CI 0.61, 0.68]), 33% (0.67 [0.64, 0.69]), 32% (0.68 [0.64, 0.72]) and 24% (0.76 [0.74, 0.79]) lower odds of initiating SGLT2is, respectively, than White participants. Disparities ameliorated from 50-60% lower odds in 2013 to 17-18% in 2019. Similar patterns were observed for GLP-1RA uptake among Black participants. By contrast, Hispanic participants had similar odds of SGLT2i initiation in the HF and CKD cohorts as White participants, but 6% (0.94 [0.91, 0.98]) lower odds in the ASCVD cohort. Notable disparities for Hispanic participants compared with White participants were observed for GLP-1RA uptake in the HF, ASCVD, CKD and no cardiorenal conditions cohorts: 11% (0.89 [0.84, 0.94]), 16% (0.84 [0.81, 0.87]), 16% (0.84 [0.80, 0.89]) and 25% (0.75 [0.72, 0.78]) lower odds, respectively. Participants had greater odds than White participants of initiating DPP4is, which confer no cardiorenal benefits, across all cohorts (HF 1.25 [1.19, 1.31]; ASCVD 1.36 [1.32, 1.40]; CKD 1.32 [1.26, 1.38). Adjustment for social determinants of health did not meaningfully change the study findings. CONCLUSIONS/
interpretationCompared with White participants, disparities in the uptake of SGLT2is were evident for Black participants, and in the uptake of GLP-1RAs for both Black and Hispanic participants. This study highlights how type 2 diabetes management is evolving, while underscoring historical imbalances that have shown signs of abatement.
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