The following is a summary of the “Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States,” published in the January 2023 issue of Kidney medicine by Zhao, et al.

Little data exist on the racial and ethnic differences in the initiation of sodium/glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) in patients with chronic kidney disease (CKD). In this study, they looked at a Medicare Fee-For-Service sample of people with CKD and type 2 diabetes and analyzed the demographic and clinical characteristics linked to starting treatment with SGLT2i, GLP-1RA, or second-generation sulfonylureas. 

Among the 53,029 persons (18 and over) with CKD and type 2 diabetes, 10.0% had a first prescription for an SGLT2i, 17.4% for a GLP-1RA, and 72.6% for a sulfonylurea. Compared to sulfonylureas, individuals aged 75 and more showed reduced probabilities of initiating SGLT2i or GLP-1RA than those aged 65-74. SGLT2i (OR, 0.67; 95% CI, 0.61-0.74) and GLP-1RA (OR, 0.73; 95% CI, 0.68-0.79) beginning rates were lower in Black patients than in White patients. In addition, GLP-1RA was less likely to be started in patients of Hispanic and Asian descent. 

An increased likelihood of initiating SGLT2i or GLP-1RA therapy was observed in patients with cardiovascular disease or hyperlipidemia. Diagnosis or procedure codes were used to determine the presence of CKD and type 2 diabetes, the CKD stage, and the patient’s clinical condition. When using historical data, there is always a chance of introducing residual confounding. This study saw discrepancies between SGLT2i and GLP-1RA usage in CKD patients. Less often than second-generation sulfonylureas, SGLT2i and GLP-1RA were started by patients of color and the elderly.

Source: sciencedirect.com/science/article/pii/S2590059522001960