PHILADELPHIA — Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure and progression of kidney disease among patients with Type 2 diabetes, but use of the therapy is less likely to occur when patients are female or members of minority groups, according to a new study.
“Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status,” wrote the authors from the Perelman School of Medicine at the University of Pennsylvania and the Corporal Michael J. Crescenz VAMC, both in Philadelphia.
That occurs, according to the article in JAMA Network Open, even though some minority groups “have a disproportionate burden of cardiovascular and chronic kidney disease (CKD).”1
Researchers sought to assess whether inequities based on race/ethnicity, gender and socioeconomic status exist in SGLT2 inhibitor use among patients with Type 2 diabetes in the U.S.
The retrospective cohort study of commercially insured patients in the United States was performed from Oct. 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Evaluated in the analysis were adult patients with a diagnosis of Type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD) or CKD. Defined as the main outcomes and measures was prescription of an SGLT2 inhibitor.
Results indicated that, of 934,737 patients with Type 2 diabetes—with a mean age of 65.4, 50.7% female; 57.6% white—81,007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with Type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%, according to the authors.
Interestingly, they noted, among patients with Type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but was lower than that among all patients with Type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%).
The study determined in multivariable analyses that Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98) and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use. On the other hand, higher median household income (≥$100 000: aOR, 1.08 [95% CI, 1.05-1.10]; $50 000-$99 999: aOR, 1.05 [95% CI, 1.03-1.07] vs. <$50 000) was associated with a higher rate of SGLT2 inhibitor use. Researchers found similar results among patients with HFrEF, ASCVD and CKD.
“In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD,” the authors concluded. “Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US.”
- Eberly LA, Yang L, Eneanya ND, Essien U, Julien H, Nathan AS, Khatana SAM, Dayoub EJ, Fanaroff AC, Giri J, Groeneveld PW, Adusumalli S. Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US. JAMA Netw Open. 2021 Apr 1;4(4):e216139. doi: 10.1001/jamanetworkopen.2021.6139. PMID: 33856475; PMCID: PMC8050743.