OBJECTIVES: Newer glycemic agents, specifically glucagon-like peptide 1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), have proven cardiorenal benefits. Despite this strong evidence of benefits, uptake has been poor. We examined (1) the uptake and geographic variations associated with the use of GLP-1RA or SGLT2i compared to dipeptidyl peptidase 4 inhibitors (DPP-4i) or sulfonylureas (SFU) and (2) initiation among high-risk cardio and renal patients.

METHODS: A retrospective cohort analysis was conducted using Tennessee Population Health Data Network (TNPOPnet), a database containing records of patients predominantly African Americans and living in medically underserved areas in the Mid-South. Adult patients with type 2 diabetes, only on metformin were identified in 2019 and followed till 2021 to see if they initiated therapy with SFU, DPP-4i, GLP-1RA, SGLT2i, or their combinations. We used geographic information systems (ArcGIS) mapping to link addresses with neighborhood-level risk factors assessed at the census tract level. Using a logistic regression model, we examined the association of cardio/renal comorbidities and neighborhood-level risk factors with the uptake of newer agents.

RESULTS: Of 331 patients who initiated second-line diabetes therapy, 37.4% started GLP-1RA or SGLT2i. Obese and patients with prior history of chronic kidney disease were more likely to start GLP-1RA or SGLT2i than DPP-4i or SFU (OR 2.39 [95% CI 1.22–4.68] for obesity, and OR 3.70 [95% CI 1.33–10.29] for CKD). Patients who lived in neighborhoods with a higher proportion of individuals with at least bachelor's degrees were more likely to receive GLP-1RA or SGLT2i (OR 1.05 [95% CI 1.01–1.09]). Newer medications were more likely to be started by females and younger patients.

CONCLUSION: Our findings highlight a suboptimal uptake of newer diabetic agents among vulnerable populations in the Mid-South. Thus, a need for more awareness of the benefits of these agents beyond their glycemic properties.