Continuous variables were compared using the Student test, and categorical variables were compared using the 2 2 test. To assess the association of race/ethnicity with the use of an SGLT2 inhibitor, we estimated multivariable logistic regression models with use of an SGLT2 inhibitor as the dependent variable and independent variables that included age, gender, race/ethnicity (Black, Latinx, White, or Asian), region of residence, zip codeClinked household income, health insurance subset (commercial only or Medicare Advantage, which provides Medicare benefits through United Healthcare), hyperlipidemia, coronary artery disease, cerebrovascular disease, CKD, hypertension, obesity, peripheral vascular disease, HFrEF, heart failure with preserved ejection fraction (HFpEF), number of Elixhauser comorbidities,28 number of visits to a cardiologist per 12 months, number of visits to an endocrinologist per 12 months, insulin use, and metformin use. For E 64d (Aloxistatin) subgroup analyses, we included the same covariates for analysis of patients with ASCVD. 2 diabetes in the US? Findings In a 5-year cohort study of 934?737 commercially insured US patients with type 2 diabetes, the frequency of SGLT2 inhibitor use increased, E 64d (Aloxistatin) but use remained low even among patients with heart failure, kidney E 64d (Aloxistatin) disease, and cardiovascular disease. Black race, female gender, and lower household income were associated with lower rates of SGLT2 inhibitor use. Meaning In this study, racial/ethnic, gender, and socioeconomic inequities were present in access to SGLT2 inhibitor treatment, which if unaddressed, may widen disparities in kidney and cardiovascular outcomes in the US. Abstract Importance Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with type 2 diabetes. Black individuals have a disproportionate burden of cardiovascular and chronic kidney disease (CKD). Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status. Objective To E 64d (Aloxistatin) assess whether inequities based on race/ethnicity, gender, and socioeconomic status exist in SGLT2 inhibitor use among patients with type 2 diabetes in the US. Design, Setting, and Participants This retrospective cohort study of commercially insured patients in the US was performed from October 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Adult patients with a diagnosis of type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or CKD, were evaluated in the analysis. Main Outcomes and Measures Prescription of an SGLT2 inhibitor. Multivariable logistic regression models were used to assess the association of race/ethnicity, gender, and socioeconomic status with SGLT2 inhibitor use. Results Of 934?737 patients with type 2 diabetes (mean [SD] age, 65.4 [12.9] years; 50.7% female; 57.6% White), 81?007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but LIMK1 was lower than that among all patients with type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%). In multivariable analyses, Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98), and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use, whereas higher median household income ($100?000: aOR, 1.08 [95% CI, 1.05-1.10]; $50 000-$99 999: aOR, 1.05 [95% CI, 1.03-1.07] vs $50 000) was associated with a higher rate of SGLT2 inhibitor use. These results were similar among patients with HFrEF, ASCVD, and CKD. Conclusions and Relevance In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD. Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US. Introduction Diabetes is significantly associated with development of cardiovascular and kidney disease in the US.1,2 Sodium-glucose cotransporter 2 (SGLT2) inhibitors decrease kidney glucose reabsorption and thereby increase urinary glucose excretion and improve in blood glucose levels.3 In addition to improved glycemic control, since publication of the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus (EMPA-REG) in 2015,4 studies have demonstrated substantial classwide cardioprotective and kidney-protective effect of this medication.5 Among patients with type 2 diabetes at high risk for cardiovascular events, SGLT2 inhibitor use has been shown to significantly reduce death from cardiovascular causes and to lower the risk of hospitalization for heart failure and progression of kidney disease.4,6 Rates of worsening heart failure or cardiovascular death are lower.
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