Rochester, MN—New medications for type 2 diabetes (T2D) don’t have the same risks for hypoglycemia or weight gain as some older products, but they tend to be less available to certain patients, including those who are members of minority groups, who are poor, or who aren’t covered by commercial insurance.

That’s according to presentations at the virtual annual scientific sessions of the American Diabetes Association.

Mayo Clinic–lead researchers point out that DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors have low hypoglycemia risk, do not cause weight gain, and postmarketing outcomes trials indicate cardiovascular and renal benefits with GLP-1RA and SGLT2i use. 

The researchers used 2013-2016 data to document low and delayed early adoption of SGLT2i among Medicare Advantage (MA) beneficiaries compared with commercial beneficiaries, despite similar formulary coverage. 

“With greater experience using these medications and emerging evidence supporting their preferred use by patients with comorbidities, prescribing patterns may have changed,” the study team posited.

Researchers used OptumLabs Data Warehouse, a de-identified dataset of commercial and MA beneficiaries, to examine the proportions of pharmacologically treated adults with T2D with commercial versus public insurance who filled a DPP-4i, GLP-1RA, or SGLT2i claim each quarter between 2013-2018. 

Results indicate significant differences across medications and health plans. Overall, after adjusting for age, gender, race/ethnicity, baseline medications, year, prescriber specialty, and comorbidities, the authors report that the odds of DPP-4i, GLP-1RA, and SGLT2i use were significantly lower for MA versus commercial beneficiaries: OR 0.61 (95% CI, 0.60-0.63), 0.45 (95% CI, 0.44-0.46), and 0.31 (95% CI, 0.30-0.31), respectively. 

“These findings call for better understanding of non-clinical factors contributing to treatment decisions,” the researchers advise.

Another presentation demonstrates that patients who are racial/ethnic minorities and/or lower socioeconomic status (SES) also appear to be undertreated with the newer pharmaceuticals. The Johns Hopkins Bloomberg School of Public Health–led study points out that those patients “have a higher burden of coronary artery disease, chronic kidney disease, and hypoglycemia. Therefore, these groups may especially benefit from newer diabetes medication classes (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors), but high cost may limit access.”

For the study, researchers conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) randomized trial to assess the associations of race/ethnicity and SES with newer diabetes medication use. In Look AHEAD, U.S. adults with obesity and T2D took part in an intensive lifestyle intervention from 2001 to 2004. As part of the study, medications, all prescribed outside of the study, were documented yearly. 

Of 4,892 participants, 64%, 16%, 13%, and 8% were white, black, Hispanic, and other race/ethnicities, respectively, with 44% initiating a newer diabetes medication over a median follow-up of 8.3 years.

Results indicate that black race was associated with significantly lower initiation of newer medications compared with white race (HR 0.81; 95% CI, 0.80-0.94), although no difference was identified by other racial/ethnic groups.

In addition, researchers point out that yearly family income was inversely associated with the outcome: HR 0.69 (95% CI, 0.55-0.87) comparing the lowest versus the highest income group. On the other hand, education, employment, and health insurance were not found to be significantly associated with the outcome. 

“These findings provide evidence of racial and SES disparities in use of newer diabetes medications, independent of glycemic control, that may impede access to these drugs for the individuals who need them most,” the researchers conclude.
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