Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study

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Background: Low socioeconomic position may affect initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucacon-like-peptide-1 receptor agonists (GLP-1RA) among patients with type 2 diabetes (T2D). We examined the association between socioeconomic position and initiation of SGLT-2i or GLP-1RA in patients with T2D at time of first intensification of antidiabetic treatment. Methods: Through nationwide registers, we identified all Danish patients on metformin who initiated second-line add-on therapy between December 10, 2012, and December 31, 2020. For each time period (2012-2014, 2015-2017, and 2018-2020), we used multivariable multinomial logistic regression to associate disposable income, as proxy for socioeconomic position, with the probability of initiating a specific second-line treatment at time of first intensification. We reported probabilities standardised to the distribution of demographics and comorbidities of patients included in the last period (2018-2020). Findings: We included 48915 patients (median age 62 years; 61·7% men). In each time period, high-income patients were more often men and had less comorbidities as compared with low income-patients. In each time period, the standardised probability of initiating a SGLT-2i or a GLP-1RA was significantly higher in the highest income group compared with the lowest: 11·4% vs. 9·5% (probability ratio [PR] 1·21, 95 % confidence interval [CI] 1·01-1·44) in 2012-2014; 22·6% vs. 19.6% (PR 1·15, CI 1·05-1·27) in 2015-2017; and 65·8% vs. 54·8% (PR 1·20, CI 1·16-1·24) in 2018-2020. The differences by income were consistent across multiple subgroups. Interpretation: Despite a universal healthcare system, low socioeconomic position was consistently associated with a lower probability of initiating a SGLT-2i or a GLP-1RA. These disparities may widen the future socioeconomic gap in cardiovascular outcomes. Funding: The work was funded by unrestricted grants from ‘Region Sjaelland Den Sundhedsvidenskabelige Forskningsfond’ and ‘Murermester Lauritz Peter Christensen og hustru Kirsten Sigrid Christensens Fond’.

OriginalsprogEngelsk
Artikelnummer100308
TidsskriftThe Lancet Regional Health - Europe
Vol/bind14
ISSN2666-7762
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
ACF has received grants from ‘Region Sjaelland Den Sundhedsvidenskabelige Forskningsfond’ and from ‘Murermester Lauritz Peter Christensen og hustru Kirsten Sigrid Christensens Fond’ for the conduct of this study. EF has received grants from Novo Nordisk, unrelated to the submitted work. LK has received speaker honorarium from Novo Nordisk, AstraZeneca, Novartis, and Boehringer Ingelheim, unrelated to the submitted work. CTP has received grants from Bayer and Novo Nordisk, unrelated to the submitted work. GHG has Novo Nordisk stocks. MS has received speaker honorarium from Novo Nordisk, AstraZeneca, Boehringer Ingelheim, and Novartis, unrelated to the submitted work. NEB has received grants from Novo Nordisk, unrelated to the submitted work. ACR has received speaker honorarium from Novartis, unrelated to the submitted work. All other authors have no declaration of interests.

Funding Information:
The work was funded by unrestricted grants from ‘Region Sjaelland Den Sundhedsvidenskabelige Forskningsfond’ and ‘Murermester Lauritz Peter Christensen og hustru Kirsten Sigrid Christensens Fond’ who had no influence on the analyses or manuscript.

Funding Information:
ACF, MS, TAG, NEB, and ACR contributed to the conception or design of the work. ACF, ACR, and TAG managed the data and the statistical analyses. ACF drafted the manuscript. All authors critically reviewed the results, revised the manuscript, gave final approval and agree to be accountable for all aspects of the work ensuring integrity and accuracy. Data are available at the highly protected servers held by Statistics Denmark, the central authority on Danish statistics. Data are anonymised, in accordance with Danish law, and all analyses need to be performed at the servers of Statistics Denmark. Only Danish research environments are granted authorisation from Statistics Denmark. However, foreign researchers, can get access through an affiliation to a Danish authorised research environment.

Publisher Copyright:
© 2022 The Author(s)

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