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GLP-1 Receptor Agonists Underused

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GLP-1 Receptor Agonists Underused

Glucagon-like peptide-1 (or GLP-1) receptor agonists are some of the most effective treatments we have for type 2 diabetes. So why aren’t more Americans taking advantage of them? That’s the question posed by a new study reporting the use of these agents is low — especially among certain ethnic and minority populations.

GLP-1 receptor agonists imitate the action of a hormone called glucagon-like peptide-1, which causes the body to secrete more insulin after meals, helping lower blood sugar levels. They also help promote weight loss. Ones in use today include dulaglutide (brand name Trulicity), exenatide (Byetta), exenatide extended-release (Bydureon), semaglutide (Ozempic, Rybelsus), liraglutide (Victoza), and lixisenatide (Adlyxin). All are administered by injection except Rybelsus, a once-daily pill that was approved for use in the United States in September 2019. In recent years several large randomized clinical trials have shown that GLP-1 receptor agonists also are effective as cardioprotective therapy, especially in people with type 2 diabetes who have established atherosclerotic cardiovascular disease (ASCVD).

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The authors of the new study obtained their data form the OptumInsight Clinformatics Data Mart database (Optum Inc.), a private payer claims database of recipients of commercial health insurance and Medicare Advantage health plans that includes inpatient, outpatient, and pharmacy claims of more than 17 million patients from all 50 states as well as information on the age, sex, race, and ethnicity of the patients. The researchers collected data over a study period from 2015 to 2019 on 1,180,260 people with type 2 diabetes. Their ages ranged from 59 to 76, with a median age of 69, and the numbers of men and women were about equal. Of these patients, 58% were white, 15% were Hispanic, 12.4% were black, and 4.4% were Asian.

Endocrinologist visits linked to increased GLP-1 use

The researchers determined that only 7.7% of the patients, no matter what their race or income, were treated with GLP-1 receptor agonists, although the percentage rose from 3.2% to 10.7% from 2015 to 2019. However, when the researchers considered racial and ethnic factors, they discovered that Asian, Hispanic, and Black patients had an even lower use of GLP-1 receptor agonists. This was troubling because, as the authors put it, “while the diabetes-related risk for coronary heart disease has declined among White patients since 1990, it has doubled among Black patients.” Income was a factor — patients in households with incomes above $50,000 were more likely to be treated with GLP-1 receptor agonists than those with lower incomes. Somewhat surprisingly, women were more likely to be prescribed a GLP-1 receptor agonist than men. The strongest element, it turned out, was whether patients visited an endocrinologist — patients who had seen an endocrinologist one or more times during a single year were much more likely to be using a GLP-1 receptor agonist. In a similar fashion, making more visits to a cardiologist during a one-year period was also associated with an increased use of the medications.

In speculating on the reason for the discrepancies, the authors said, “Patients of racial and ethnic minority groups consistently have inequitable access to guideline-based therapeutics that improve cardiovascular disease burden and outcomes, despite often experiencing a disproportionately higher rate of these conditions.” As for Asian patients, who had the lowest rates of GLP-1 receptor agonist use, the researchers wrote, “Barriers to accessing care, less patient-centered interactions by practitioners, and biases in care delivery have been well-documented among Asian patients.” Cost seemed to be a major factor in general. Although users of GLP-1 receptor agonists had a median 30-day copayment of $40, this amount applied only to patients who filled their prescriptions. Those who didn’t might have been discouraged by higher copayments.

In conclusion, the researchers wrote, “A better understanding of the barriers to [GLP-1 receptor agonist] use among [the Black population] and other marginalized groups is needed…. Inequitable uptake must be addressed to prevent the widening of racial and ethnic disparities in cardiovascular disease and outcomes in the U.S.”

Want to learn more about GLP-1 drugs? Read “GLP-1 Agonists: Getting to Know These Diabetes Drugs Better.”

Joseph Gustaitis

Joseph Gustaitis

Joseph Gustaitis on social media

A freelance writer and editor based in the Chicago area, Gustaitis has a degree in journalism from Columbia University. He has decades of experience writing about diabetes and related health conditions and interviewing healthcare experts.

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