Racial, economic disparities found in use of SGLT-2 inhibitors

Although use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors rose overall between 2015 and 2019, patients who were Black, Asian, female, or with lower household income had lower rates of prescriptions for the drug class than others with type 2 diabetes.


Use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors increased among patients with type 2 diabetes from 2015 to 2019 but remained uncommon among patients with heart failure with reduced ejection fraction, chronic kidney disease (CKD), and atherosclerotic cardiovascular disease, a study found.

To assess disparities in SGLT-2 inhibitor prescribing, researchers conducted a retrospective cohort study of commercially 934,737 insured U.S. patients from October 2015 to June 2019. Mean age was 65.4 years, 50.7% were women, and 57.6% were White. Results were published April 15 by JAMA Network Open.

Overall, 81,007 of 934,737 patients with type 2 diabetes (8.7%) were treated with an SGLT-2 inhibitor. From 2015 to 2019, the percentage of patients treated with an SGLT-2 inhibitor increased from 3.8% to 11.9%. The rate of use increased from 3.4% to 11.4% among Asian patients, 3.4% to 11.1% among Black patients, 3.8% to 13.0% among Latino patients, and 4.0% to 12.6% among White patients. SGLT-2 inhibitor use also increased from 2015 to 2019 among 26,054 patients with heart failure with reduced ejection fraction (1.9% to 7.6%), in 594,058 patients with atherosclerotic cardiovascular disease (3.0% to 9.8%), and in 92,485 patients with CKD (2.1% to 7.5%).

Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81 to 0.85), Asian race (aOR, 0.94; 95% CI, 0.90 to 0.98), and female gender (aOR, 0.84; 95% CI, 0.82 to 0.85) were associated with lower rates of use. Compared to patients with an income less than $50,000 per year, adjusted odds ratios for SGLT-2 inhibitor therapy were 1.05 (95% CI, 1.03 to 1.07) for patients making $50,000 to $99,999 and 1.08 (95% CI, 1.05 to 1.10) for those making at least $100,000. The researchers also found that having visited an endocrinologist in the past 12 months was one of the strongest factors associated with SGLT-2 inhibitor use and noted that the clinical benefits may not yet have been common knowledge among nonsubspecialist physicians at the time of their study.

No data were available on physicians' decision making regarding therapy or on patients' diabetes severity, among other limitations, the authors said. They concluded that racial, gender, and socioeconomic inequities exist in access to SGLT-2 inhibitor treatment and called for further studies to examine potential barriers and ensure equitable access.