Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study

• Published in: Journal of general internal medicine : JGIM 2024-11, Vol.39 (15), p.2987-2994
• Main Authors: Bepo, Lurit, Nguyen, Oanh K., Makam, Anil N.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Aged; Beneficiaries; Cohort Studies; Cross-Sectional Studies; Cultural differences; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - ethnology; Drugs; Ethnicity; Female; GLP-1 receptor agonists; Glucagon; Glucagon-like peptide 1; Glucagon-Like Peptide-1 Receptor - agonists; Glucose transporter; Government programs; Health care access; Health disparities; Health insurance; Health surveys; Healthcare Disparities - economics; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hispanic Americans; Humans; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Insurance; Insurance coverage; Insurance Coverage - statistics & numerical data; Insurance, Health - statistics & numerical data; Internal Medicine; Male; Medicaid; Medicaid - statistics & numerical data; Medicare; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Minority & ethnic groups; Morbidity; Original Research; Pharmacists; Population studies; Race; Socioeconomic factors; Sodium-Glucose Transporter 2 Inhibitors - economics; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; United States - epidemiology
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-024-08961-x

Background Minority racial and ethnic populations have the highest prevalence of type 2 diabetes mellitus but lower use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra), novel medications that reduce morbidity and mortality. Observed disparities may be due to differences in insurance coverage, which have variable cost-sharing, prior authorization, and formulary restrictions that influence medication access. Objective To assess whether racial/ethnic differences in SGLT2i and GLP1ra use differ by payer. Design Cross-sectional analysis of 2018 and 2019 Medical Expenditure Panel Survey data. Participants Adults ≥ 18 years old with diabetes. Main Measures We defined insurance as private, Medicare, or Medicaid using ≥ 7 months of coverage in the calendar year. We defined race/ethnicity as White (non-Hispanic) vs non-White (including Hispanic). The primary outcome was use of ≥ 1 SGLT2i or GLP1ra medication. We used multivariable logistic regression to assess the interaction between payer and race/ethnicity adjusted for cardiovascular, socioeconomic, and healthcare access factors. Key Results We included 4997 adults, representing 24.8 million US adults annually with diabetes (mean age 63.6 years, 48.8% female, 38.8% non-White; 33.5% private insurance, 56.8% Medicare, 9.8% Medicaid). In our fully adjusted model, White individuals with private insurance had significantly more medication use versus non-White individuals (16.1% vs 8.3%, p