b'GLP-1 RAs, Other Agents, Underused in Patients Who Need Them the Most By Brenda L. MooneyBETHESDA,MDWhilenewsreportsfocusonType 2 diabetes. The cross-sectional analysis used highdemandforglucagon-likepeptide-1receptordatafromtheVHAsCorporateDataWarehouse. agonists (GLP-1 RA), the real story might be wide- Included in the study were adult patients with type spread underuse of those agents and others that re- 2 diabetes and at least two primary care clinic visits duce the risk of cardiovascular disease and chronicfrom Jan. 1, 2019, to Dec. 31, 2020.kidney disease progression in patients with Type 2Researchers from the University of California San diabetes. FranciscoandtheSanFranciscoVAHealthcare A recent study from Walter Reed National MilitarySystem defined the primary outcomes as any active MedicalCenterandtheUniformedServicesSGLT2i or GLP-1 RA prescription during the study University,bothinBethesda,MD,decriedhesi- period. 2tancytoprescribeguideline-directeddrugthera- The1.2million VHApatients,96%men,hada pies,includingGLP-1RAs,thatoffersubstantialmean age of 68 years. The racial/ethnic breakdown cardiorenalbenefits,improvedqualityoflifeandwas:longevityinpatientswithchronickidneydisease 1% American Indian or Alaska Native, (CKD) and Type 2 diabetes. Other treatment options 2% Asian, Native Hawaiian, or Other Pacific includesodium-glucosecotransporter-2inhibitorsIslander, (SGLT2i) and nonsteroidal mineralocorticoid recep-7% of Hispanic or Latino, tor antagonists.20% Black or African American, andHowever, despite compelling evidence from mul-71% white.tipleclinicaltrials,theiruptakehasbeenslowinDuringthestudyperiod,only10.7%and7.7% routine clinical practice, reminiscent of the historicalwere prescribed an SGLT2i or a GLP-1 RA, respec-evolution of angiotensin-converting enzyme inhibitortively. Researchers reported that prescription rates and angiotensin II receptor blocker use, the authorsforSGLT2iandGLP-1RA,respectively,were wrote in Nephrology Dialysis Transplantation. 1 11% and 8.4% among American Indian or Alaska The VA hasnt fared much better. Prescription ratesNativepatients;11.8%and8%amongAsian, remain low for novel therapies for Type 2 diabetesNative Hawaiian or Other Pacific Islander patients; therapies that have been proven to reduce the risk8.8% and 6.1% among Black or African-American of cardiovascular disease and chronic kidney diseasepatients; and 11.3% and 8.2% among white patients, progression. Compounding the issue is that, com- respectively. pared with white veterans, those of all other racialPrescriptionratesforSGLT2iandGLP-1RA, groupshadsignificantlyloweroddsofprescrip- respectively, were 11% and 7.1% among Hispanic tions for sodium-glucose cotransporter-2 inhibitorsor Latino patients and 10.7% and 7.8% among non-(SGLT2i) and glucagon-like peptide-1 receptor ago- Hispanic or Latino patients. nists (GLP-1 RA), with Hispanic patients the leastAfter accounting for patient- and system-level fac-likely. tors, all racial groups had significantly lower odds of A study in JAMA last year looked at prescriptionSGLT2i and GLP-1 RA prescription compared with equitability among more than 1 million patients withwhite patients. Black patients had the lowest odds of 92'