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

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Eric Wang, Elisabetta Patorno, Farzin Khosrow-Khavar, Stephen Crystal, Chintan V. Dave
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引用次数: 0

Abstract

Aims/hypothesis

The 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.

Methods

Using 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.

Results

Black 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/interpretation

Compared 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.

Graphical Abstract

Abstract Image

2013-2019年2型糖尿病合并心力衰竭、动脉粥样硬化性心血管疾病和慢性肾病的医疗保险受益人在服用SGLT2is和GLP-1RAs方面的种族和民族差异
目的/假设本研究旨在调查患有 2 型糖尿病和心力衰竭的老年人使用钠-葡萄糖共转运体 2 抑制剂 (SGLT2is) 和胰高血糖素样肽-1 受体拮抗剂 (GLP-1RA) 的种族和民族差异。方法利用医疗保险付费服务数据(2013-2019 年),这项回顾性队列研究确定了开始接受二线疗法(SGLT2is、GLP1-RAs、二肽基肽酶-4 抑制剂 [DPP4is] 和磺脲类药物 [SUs])的 2 型糖尿病老年人(≥65 岁),同时患有 (1)心力衰竭 (HF)、(2) 动脉粥样硬化性心血管疾病 (ASCVD)、(3) 慢性肾脏疾病 (CKD) 和 (4) 无记录的心肾疾病。参与者分为非西班牙裔白人、非西班牙裔黑人和西班牙裔。在对社会人口学、临床和县级特征进行调整后,采用多项式回归法对每个队列中开始使用 SGLT2is 或 GLP-1RAs 的几率进行建模。结果患有高血压、ASCVD、慢性肾脏病或无心肾疾病记录的黑人参与者开始使用 SGLT2is 的几率分别比白人参与者低 35% (调整后 OR 0.65 [95% CI 0.61, 0.68])、33% (0.67 [0.64, 0.69])、32% (0.68 [0.64, 0.72])和 24% (0.76 [0.74, 0.79])。差距从 2013 年的 50-60% 下降到 2019 年的 17-18%。在黑人参与者中也观察到了类似的 GLP-1RA 摄入模式。相比之下,西班牙裔参与者在高血压和慢性肾脏病队列中开始使用 SGLT2i 的几率与白人参与者相似,但在 ASCVD 队列中几率要低 6% (0.94 [0.91, 0.98])。与白人参与者相比,西班牙裔参与者在高血压、ASCVD、慢性肾功能衰竭和无心肾疾病队列中摄入 GLP-1RA 的比例存在显著差异:分别低 11% (0.89 [0.84, 0.94])、16% (0.84 [0.81, 0.87])、16% (0.84 [0.80, 0.89])和 25% (0.75 [0.72, 0.78])。与白人参与者相比,所有组群的参与者开始服用 DPP4is 的几率更大,而 DPP4is 对心血管无益(HF 1.25 [1.19, 1.31];ASCVD 1.36 [1.32, 1.40];CKD 1.32 [1.26, 1.38])。结论/解释与白人参与者相比,黑人参与者在服用 SGLT2is 方面存在明显差异,黑人和西班牙裔参与者在服用 GLP-1RAs 方面也存在明显差异。这项研究突显了 2 型糖尿病管理的演变过程,同时也强调了历史上的不平衡现象,而这种不平衡现象已经出现了缓解的迹象。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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