Sociodemographic disparities in the use of GLP-1 receptor agonists and SGLT-2 inhibitors among US adults with type 2 diabetes: NHANES 2005-March 2020

Abstract

AbstractAimType 2 Diabetes (T2D) is a major cause of morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are highly effective but underutilized. We assessed racial/ethnic and other sociodemographic disparities in GLP-1/SGLT-2 use among US adults with T2D.Materials and MethodsWe conducted a retrospective analysis using nationally representative data from National Health and Nutrition Examination Survey 2005-March 2020. Participants were adults with T2D taking ≥1 diabetes medication, excluding pregnant women and adults with probable T1D. We performed univariate analyses to examine characteristics of patients using GLP-1/SGLT-2 and multivariable logistic regression to assess disparities in GLP-1/SGLT-2 use after adjusting for other patient factors.ResultsAmong 4,585 T2D patients (representing >18 million US adults) taking ≥1 medication, GLP-1/SGLT-2 usage increased from 1.4% in 2005-2006 to 13.3% in 2017-2020. In univariate analyses, patients using GLP-1/SGLT-2 vs. other T2D drugs were more likely to be white than nonwhite (72% vs. 60%, p = .001), but in multivariable analysis there was no significant difference in GLP-1/SGLT-2 use for nonwhite vs. white patients (aOR = 0.84, 95% CI [0.61, 1.16]). GLP-1/SGLT-2 use was higher for patients who completed some college (aOR = 1.83, 95% CI [1.06, 3.15]) or above (aOR = 2.06, 95% CI [1.28, 3.32]) vs. high school or less, and for those with an income-poverty ratio ≥4 vs. <2 (aOR = 2.11, 95% CI [1.30, 3.42]).ConclusionsUse of GLP-1/SGLT-2 drugs increased over time but remained low in March 2020. Higher education and income, but not race/ethnicity, were associated with GLP-1/SGLT-2 use.