ECONOMIC BURDEN AND USE OF GLUCOSE-LOWERING MEDICATIONS IN U.S. ADULTS WITH DIABETES, BY CARDIOVASCULAR-KIDNEY-METABOLIC COMPONENTS: 2012-2021
Author(s)
Shanshan Li, Master1, Xinyi Zhu, Master2, Shuijing Wang, Master3, yuzhi han, Master4, Ming Xu, PHD5, Beini Lyu, MD4;
1Department of Global Health, School of Public Health,Peking university, STUDENT, BEIJING, China, 2Beijing-Dublin International College, Beijing University of Technology, STUDENT, BEIJING, China, 3School of Public Health,Peking university, Beijing, China, 4Institute for Global Health and Development, Peking University, Beijing, China, 5Department of Global Health, School of Public Health,Peking university, BEIJING, China
1Department of Global Health, School of Public Health,Peking university, STUDENT, BEIJING, China, 2Beijing-Dublin International College, Beijing University of Technology, STUDENT, BEIJING, China, 3School of Public Health,Peking university, Beijing, China, 4Institute for Global Health and Development, Peking University, Beijing, China, 5Department of Global Health, School of Public Health,Peking university, BEIJING, China
OBJECTIVES: Diabetes is a key component of the cardiovascular-kidney-metabolic (CKM) continuum; when cardiovascular and/or kidney disease co-occurs, premature mortality risk and pharmacological needs increase. Yet how prescription medication expenditures—particularly spending on glucose-lowering drugs—vary across CKM comorbidity profiles, and whether spending patterns align with guideline-recommended therapy, remain unclear. We assessed national trends in medication expenditures and glucose-lowering drugs (GLD) use among U.S. adults with diabetes, stratified by CKM components.
METHODS: We analyzed 2012-2021 Medical Expenditure Panel Survey data. Adults with diabetes were stratified into four mutually exclusive groups based on CKM components: diabetes alone (D only), with cardiovascular disease (D+C), with chronic kidney disease (D+K), and with both conditions (D+K+C). We evaluated trends in per-capita expenditures for total prescription and GLD and the utilization of SGLT2i and GLP-1 RA, two GLD classes with established cardiorenal benefits.
RESULTS: The sample included 130,738 adults (mean age 49 years; 53.6% female): 68.6% D only, 22.7% D+C, 4.9% D+K, and 3.8% D+C+K. Total prescription and GLD expenditures increased substantially over time across groups. Per-capita total prescription spending and GLD spending increased with CKM burden (in 2020-2021: total prescription $5,328 in D only, $8,526 in D+C, $9,866 in D+K, and $9,970 in D+K+C; GLD: $3,343 in D only, $3,931 in D+C, $5,614 in D+K, and $5,940 in D+K+C). Insulin constituted 60.3% of total GLD costs, with significant higher expenditures in patients with cardiovascular or kidney disease. In contrast, SGLT2i/GLP-1 RA use was broadly similar across comorbidity profiles (in 2021: 21.1% D only, 20.6% in D+C, 28.4% in D+K, and 19.3% in D+C+K).
CONCLUSIONS: Cardiovascular and kidney comorbidities are associated with substantially higher prescription and glucose-lowering drug expenditures among US adults with diabetes, driven largely by insulin spending. Despite guideline-supported cardiorenal benefits, SGLT2i and GLP-1 RA uptake remains suboptimal and does not meaningfully increase among higher-risk groups.
METHODS: We analyzed 2012-2021 Medical Expenditure Panel Survey data. Adults with diabetes were stratified into four mutually exclusive groups based on CKM components: diabetes alone (D only), with cardiovascular disease (D+C), with chronic kidney disease (D+K), and with both conditions (D+K+C). We evaluated trends in per-capita expenditures for total prescription and GLD and the utilization of SGLT2i and GLP-1 RA, two GLD classes with established cardiorenal benefits.
RESULTS: The sample included 130,738 adults (mean age 49 years; 53.6% female): 68.6% D only, 22.7% D+C, 4.9% D+K, and 3.8% D+C+K. Total prescription and GLD expenditures increased substantially over time across groups. Per-capita total prescription spending and GLD spending increased with CKM burden (in 2020-2021: total prescription $5,328 in D only, $8,526 in D+C, $9,866 in D+K, and $9,970 in D+K+C; GLD: $3,343 in D only, $3,931 in D+C, $5,614 in D+K, and $5,940 in D+K+C). Insulin constituted 60.3% of total GLD costs, with significant higher expenditures in patients with cardiovascular or kidney disease. In contrast, SGLT2i/GLP-1 RA use was broadly similar across comorbidity profiles (in 2021: 21.1% D only, 20.6% in D+C, 28.4% in D+K, and 19.3% in D+C+K).
CONCLUSIONS: Cardiovascular and kidney comorbidities are associated with substantially higher prescription and glucose-lowering drug expenditures among US adults with diabetes, driven largely by insulin spending. Despite guideline-supported cardiorenal benefits, SGLT2i and GLP-1 RA uptake remains suboptimal and does not meaningfully increase among higher-risk groups.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE436
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Urinary/Kidney Disorders