Racial Variations in SGLT2 Inhibitor Prescriptions

Background/Synopsis

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are novel pharmacotherapies that improve mortality and reduce hospitalizations for patients with type 2 diabetes mellitus (T2DM) suffering from heart failure and chronic kidney disease (CKD). Prescription patterns vary amongst patient racial groups in goal directed medical therapy, however, this has not been thoroughly examined for SGLT2i.

Objective/Purpose

Here, we investigate the racial differences in SGLT2i prescriptions for diabetic patients. We hypothesize that there are differences between SGLT2i prescriptions based on race, compared to prevalence of diabetes in the local population.

Methods

We performed a retrospective analysis of patients started on SGLT2i in the Northwell Health system serving the Queens and Nassau County regions of New York state. Data was collected on patients from 2018 to 2023. The racial demographics of these patients were examined and compared between various specialties (cardiology, nephrology, endocrinology and primary care providers) that started these medications.

Results

A total of 11,255 patients were started on SGLT2i in the Northwell Health central region system from 2018 to 2023. Of these patients, 6,031 (53.6%) were white, 1,465 (13.0%) were black and 892 (7.9%) were Asian. These results were further subdivided by specialty prescribing the medication. Cardiologists started 3,765 patients on SGLT2i with 2,179 (57.9%) being white, 462 (12.3%) being black and 357 (9.5%) being Asian. Nephrologists started 355 patients on SGLT2i with 162 (45.6%) being white, 67 (18.9%) being black and 43 (12.1%) being Asian. Endocrinologists started 3,979 patients on SGLT2i with 1,953 (49.1%) being white, 590 (14.8%) being black and 280 (7.0%) being Asian. Primary care providers started 3191 patients on SGLT2i with 1737 (54.4%) being white, 346 (10.8%) being black and 212 (6.6%) being Asian.

Conclusions

The Queens and Nassau counties served by the central region of Northwell Health include a diverse population. Out of the T2DM population in this area, approximately 41% is white, 20% is black and 18% is Asian. Additionally, black and Asian (particularly South Asian) populations tend to have increased incidence of cardiovascular disease and CKD. From this analysis, it is evident that black and Asian patients are being prescribed SGLT2i at a lower rate as compared to white patients. This discrepancy is most seen in primary care providers and cardiologists, but pertinent for all specialties. Although our study highlights a potential underlying bias in differences in prescriber habits across racial groups, our comparison does not adjust for other confounding factors such as insurance, drug affordability, and contraindication rates.