Work

Evidence-based SGLT2 inhibitor and GLP-1 receptor agonist use by race in the VA healthcare system

Year: 2025

Type: article

Abstract: Importance: Adoption of novel therapeutics often lags for Black versus non-Hispanic White patients. Seminal clinical trials established the cardiovascular efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease. However, it is uncertain whether race influences the evidence-based prescription of these agents. Objective: To determine whether evidence-based prescription of SGLT2i or GLP-1RA differs by Black versus White race in the Veterans Affairs (VA) healthcare system. Design Setting and Participants: Retrospective cohort study of US Veterans with T2D and angiographically confirmed coronary artery disease (CAD) at 84 VA medical centers over the period 2015-2023. Data from the VA Clinical Assessment, Reporting, and Tracking Program were used to construct cohorts eligible for SGLT2i or GLP-1RA treatment based on eligibility criteria for the seminal Empagliflozin, Cardiovascular Outcomes, and Mortality in T2D (EMPA-REG OUTCOME) or the Liraglutide Effect and Action in Diabetes (LEADER) trial, respectively. Multivariable logistic regression estimated adjusted odds of trial-concordant SGLT2i or GLP-1RA prescription by race. Exposures: Self-identified race. Main Outcomes and Measures: SGLT2i or GLP-1RA prescription among those with an evidence-based (trial-concordant) indication. Results: = 0.025). Conclusions and Relevance: Among patients with T2D and CAD in the VA healthcare system, evidence-based SGLT2i and GLP1-RA prescription increased over time, but many eligible patients remained untreated. Although SGLT2i prescription did not differ by race, Black versus White Veterans were less likely to receive evidence-based GLP1-RA prescription. Racial disparities in evidence-based cardiovascular drug prescription exist even in a healthcare system with few economic barriers and may be drug class-specific.

Source: American Journal of Preventive Cardiology

DOI: 10.1016/j.ajpc.2025.100966