New research reveals inequalities in the usage of diabetes medicine to guard towards coronary heart illness

A drug typically used to treat diabetes, glucagon-like peptide-1 receptor agonists (GLP-1 RA), could also be used to prevent cardiovascular disease and serious cardiovascular events, but a new study showed inequalities in its application based on race and ethnicity, and socio-economic status. Looking at four years of data, researchers at the University of Pennsylvania’s Perelman School of Medicine found that some groups that were historically underserved by health care were up to 41 percent less likely to use this drug . This research was published today on the JAMA Health Forum.

Cardiovascular disease is the leading killer of death in patients with type 2 diabetes, and GLP-1 receptor agonists have been shown to reduce serious adverse cardiovascular events. Our study showed significant inequalities in use among Black, Latinx, and Asian patients, as well as those of lower economic status who are less likely to be prescribed this therapy. Given the well-documented racial differences in exposure to diabetes and cardiovascular disease, we believe that the differences in the use of this therapy must be addressed to prevent unfair outcomes from worsening. “

Lauren Eberly, MD, lead study author, Clinical Fellow on Cardiovascular Disease

GLP-1-RAs are prescribed for diabetes because they help restore blood sugar balance in the body by activating receptors for the GLP-1 hormone in the pancreas to increase insulin, and at the same time the mechanisms by which blood sugar is released dampen. In addition to improving blood sugar control, the drug helps patients control their weight. Recent studies have added a new facet to the benefits of this drug: reducing heart problems, especially those related to high blood pressure. In fact, the American Diabetes Association recommends the use of GLP-1 RAs in patients with atherosclerotic cardiovascular disease, heart disease caused by buildup and blockage in arteries.

Eberly and her fellow researchers – including the study’s lead author, Srinath Adusumalli, MD, Assistant Professor of Clinical Medicine in Cardiology and Assistant Program Director of the Cardiovascular Disease Fellowship – examined data on the prescribing and use of GLP-1 RA from a perspective of race, ethnicity, and economic status. The aim was to clarify whether it was fair to take this potentially life-saving drug.

The researchers accessed anonymized data from more than one million patients with commercial health insurance who were diagnosed with type 2 diabetes between October 2015 and the end of 2018. This period was chosen because it captured a time when the cardiovascular benefits of GLP-1 use of RA were well established and well known. All patients in the study were continuously insured for at least a year before and six months after they were diagnosed with diabetes, which was important because a significant insurance loss could affect a patient’s ability to pay for a prescription.

To determine the “usage rate” of GLP-1 RA, the researchers looked at an insurance claim for a patient filling out a prescription as “using” the drug. Those suspected of not using GLP-1 RA were either not prescribed the drug in the first place or were not followed up to fill it up.

Overall, the usage rate of GLP-1 RA increased – albeit slightly – from 3.2 to 10.7 percent during the study period. In patients diagnosed with atherosclerotic cardiovascular disease, the consumption rate rose similarly from 2.8 to 9.4 percent.

An increase in prescription use was also observed with the further breakdown of the data. In black patients, the increase was from 2.9 to 10.4 percent, in Asian patients from 2 to 6.4 percent, in Latinx patients from 2.9 to 10.8 percent and in white patients from 3.6 to 11 , 7 percent observed.

However, deeper analysis showed that inequalities were widespread. Compared to white patients, black patients were 19 percent less likely to receive a GLP-1 RA prescription, Latinx patients were 9 percent less likely, and Asian patients were 41 percent less likely.

“While we cannot pinpoint the reasons for the improper use, these results persisted after adjusting for numerous variables, including clinical factors, socioeconomic factors, and even exposure to specialty care – including cardiology and endocrinology,” said Eberly. “Hence, the results show biases in healthcare that need to be corrected. We believe that these results reflect structural racism and are unfortunately one of many examples of how health systems fail to provide quality care for non-white patients. “

In addition to racial and ethnic factors, those with a household income of more than $ 100,000 were 13 percent more likely to develop GLP-1-RA than those below that income.

When investigating the use of the drug itself, the researchers found that the likelihood that a patient would have more than one visit to an endocrinologist in a year more than tripled.

“A visit to the endocrinologist was the strongest predictor of GLP-1 RA use,” said Eberly. “However, the majority of patients with diabetes are not cared for by an endocrinologist and there are also barriers to specialized care for marginalized patient groups. Therefore, it is important for all providers who care for patients with diabetes to recognize the cardioprotective agent benefiting from GLP-1 RA and take steps in their own practice to achieve fairer use. “

Source:

University of Pennsylvania