SGLT2 inhibitors — a class of drugs for type 2 diabetes that have grown in popularity in recent years — aren’t being prescribed consistently across racial groups or between men and women, according to a new study published in the journal JAMA Network Open.
While SGLT2 inhibitors were developed as drugs for type 2 diabetes and are used to lower blood glucose, they have also been shown to have other benefits, including potentially protecting people against serious kidney problems. In fact, one SGLT2 inhibitor — Farxiga (dapagliflozin) — was found in a study to have an “overwhelming” benefit in people with chronic kidney disease, and has been approved by the U.S. Food and Drug Administration (FDA) as a treatment for the condition. Farxiga is also approved as a treatment for heart failure — a condition in which the heart can’t adequately pump blood throughout the body — regardless of whether people have diabetes.
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In the latest study, researchers looked at a group of 934,737 people in the United States with type 2 diabetes over a period of five years. All of the participants had private health insurance, and their average age was 65.4 years old. The group was split nearly evenly between men and women, and 57.6% of participants were white. The researchers were interested in finding any unusual patterns or disparities in prescriptions of SGLT2 inhibitors, since these drugs aren’t simply just another glucose-lowering option, as they “significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with type 2 diabetes,” the researchers wrote. They were careful to make sure the study group included significant numbers of people with heart failure, chronic kidney disease and atherosclerotic cardiovascular disease (involving plaque buildup in the arteries).
Disparities in SGLT2 inhibitor prescriptions found
Overall, 8.7% of participants were treated with an SGLT2 inhibitor during the study period. The percentage of people taking one of these drugs grew during this period, from 3.8% to 11.9%. Strangely, though, the proportion of people with heart failure, kidney disease or cardiovascular disease who took an SGLT2 inhibitor was lower than in the overall group of people with type 2 diabetes. The proportion of people with heart failure taking an SGLT2 inhibitor grew from 1.9% to 7.6%. For people with chronic kidney disease, it grew from 2.1% to 7.5%, and for those with atherosclerotic cardiovascular disease, it grew from 3.0% to 9.8%.
There were also significant racial disparities in SGLT2 prescriptions. Black people were 17% less likely to be prescribed these drugs (after controlling for other factors associated with SGLT2 inhibitor prescriptions), and people of Asian descent were 6% less likely to take them compared with white people. Women were also 16% less likely than men to be prescribed an SGLT2 inhibitor. A higher household income made people more likely to receive an SGLT2 inhibitor prescription, with an income of at least $100,000 tied to an 8% higher rate of prescriptions, and an income of $50,000 to $99,999 tied to a 5% higher rate of prescriptions, compared with an income below $50,000. These income trends were consistent regardless of whether people had heart failure, chronic kidney disease or atherosclerotic cardiovascular disease.
The researchers concluded that there are troubling disparities in SGLT2 inhibitor prescriptions in the United States, demonstrating that these drugs aren’t being used strictly according to the medical needs of patients. “Interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes,” they wrote.
Want to learn more about SGLT2 inhibitors? Read “Diabetes Medicine: SGLT2 Inhibitors.”
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