Socioeconomic aspects of incretin-based therapy

Incretin-based therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have demonstrated cardiovascular benefits in people with type 2 diabetes. However, socioeconomic disparities in their uptake may constrain the collective advantages offered by these medications to the broad...

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Bibliographic Details
Published in:Diabetologia 2023-10, Vol.66 (10), p.1859-1868
Main Authors: Karagiannis, Thomas, Bekiari, Eleni, Tsapas, Apostolos
Format: Article
Language:English
Subjects:
Cardiovascular diseases
Diabetes
Diabetes mellitus (non-insulin dependent)
GLP-1 receptor agonists
Glucagon
Glucagon-like peptide 1
Health care
Health education
Health literacy
Human Physiology
Internal Medicine
Medicine
Medicine & Public Health
Metabolic Diseases
Patients
Review
Socioeconomic factors
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Summary:Incretin-based therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have demonstrated cardiovascular benefits in people with type 2 diabetes. However, socioeconomic disparities in their uptake may constrain the collective advantages offered by these medications to the broader population. In this review we examine the socioeconomic disparities in the utilisation of incretin-based therapies and discuss strategies to address these inequalities. Based on real-world evidence, the uptake of GLP-1 RAs is reduced in people who live in socioeconomically disadvantaged areas, have low income and education level, or belong to racial/ethnic minorities, even though these individuals have a greater burden of type 2 diabetes and cardiovascular disease. Contributing factors include suboptimal health insurance coverage, limited accessibility to incretin-based therapies, financial constraints, low health literacy and physician–patient barriers such as provider bias. Advocating for a reduction in the price of GLP-1 RAs is a pivotal initial step to enhance their affordability among lower socioeconomic groups and improve their value-for-money from a societal perspective. By implementing cost-effective strategies, healthcare systems can amplify the societal benefits of incretin-based therapies, alongside measures that include maximising treatment benefits in specific subpopulations while minimising harms in vulnerable individuals, increasing accessibility, enhancing health literacy and overcoming physician–patient barriers. A collaborative approach between governments, pharmaceutical companies, healthcare providers and people with diabetes is necessary for the effective implementation of these strategies to enhance the overall societal benefits of incretin-based therapies. Graphical Abstract
ISSN:0012-186X
1432-0428
1432-0428
DOI:10.1007/s00125-023-05962-z