Disparities in GLP-1 Receptor Agonist Use in Type 2 Diabetes

By Lisa Rapaport

January 14, 2022

(Reuters Health) - White and more affluent patients with type 2 diabetes are significantly more likely to receive glucagon-like peptide-1 (GLP-1) receptor agonist therapy than individuals who are Black, Asian, Hispanic or low-income, a U.S. study suggests.

Researchers examined commercial health insurance claims data collected from October 2015 to June 2019 on 1.18 million U.S. patients with type 2 diabetes, including 90,934 (7.7%) who received prescriptions for GLP-1 receptor agonists.

Overall, the proportion of patients with type 2 diabetes who received GLP-1 receptor agonists increased from 3.2% in 2015 to 10.7% by 2019, the analysis found. Utilization of GLP-1 receptor agonists also increased among the subset of patients who had comorbid atherosclerotic cardiovascular disease, rising from 2.8% at the beginning of the study period to 9.4% by the end.

Compared with white patients, Asian patients were significantly less likely to receive GLP-1 receptor agonists (adjusted odds ratio 0.59), as were Black (aOR 0.81), and Hispanic (aOR 0.91) patients.

Income disparities were also identified. Compared with individuals living in zip codes with median annual household income below $50,000, patients living in zip codes with median income above $100,000 (aOR 1.13) and with median income from $50,000 to $99,999 (aOR 1.07) were significantly more likely to receive GLP-1 receptor agonists.

Often, socioeconomic status and lack of health insurance are blamed for racial and ethnic inequities in health care and health outcomes, said lead study author Dr. Lauren Eberly of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

"However, the racial and ethnic disparities in GLP-1 receptor agonist use demonstrated by our study persisted after adjustment not only for clinical factors, but also for engagement with specialty care and socioeconomic status, and were in the setting of a 100% commercially insured population," Dr. Eberly said by email. "Therefore, these results reveal biases in health care delivery that must be rectified."

Patients with coronary artery disease were also significantly less likely to take GLP-1 receptor agonists (aOR 0.95), as were individuals with cerebrovascular disease (aOR 0.96) or Elixhauser comorbidities (aOR 0.93).

Specialty care appeared to increase the odds of using these drugs. People who saw an endocrinologist at least once in a 12-month period were significantly more likely to use GLP-1 receptor agonists (aOR 2.26), as were those who had at least one visit with a cardiologist (aOR 1.19).

One limitation of the study is that detailed information that informs clinical decision making isn't available in insurance claims data, the authors note in JAMA Health Forum. It's possible that patient preference might play a role in the choice to use GLP-1 receptor agonists, and that some patients may have declined these injected drugs when clinicians recommended them.

Even so, the results underscore that clinicians and healthcare systems need to do a better job of outreach to patients who may be eligible for GLP-1 receptor agonists, Dr. Eberly said.

"The majority of patients that have diabetes do not see specialists for care, and there are demonstrated inequities in accessing specialty care," Dr. Eberly said. "Therefore, it is essential that barriers be decreased, and that knowledge and comfort be increased to facilitate prescribing of these agents by primary care practitioners to all patients with type 2 diabetes and atherosclerotic cardiovascular disease risk factors, with special attention to marginalized groups of patients."

SOURCE: https://bit.ly/3K8rwXm JAMA Health Forum, online December 17, 2021.

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