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Background <p>Glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and kidney outcomes, but accessibility concerns persist. Whether access is worse in rural communities is unknown.</p> Objective <p>To examine fills of GLP1RA/SGLT2i by adults with type 2 diabetes in rural and urban US counties.</p> Design <p>Cross-sectional use claims from OptumLabs® Data Warehouse, 2012–2021.</p> Patients <p>Adults with type 2 diabetes.</p> Main Measures <p>We examined rates and odds of fills of GLP1RA or SGLT2i, adjusting for time period, age, sex, presence of cardiorenal comorbidities (heart failure [HF], atherosclerotic cardiovascular disease [ASCVD], chronic kidney disease stages 3–4 [CKD]), and rurality.</p> Key Results <p>The study included 2,579,577 adults with type 2 diabetes (mean age 63.9; 49.6% female). Compared to 2012–2015, fills of GLP1RA/SGLT2i increased in 2016–2018 (OR 2.49; 95% CI 2.47–2.52) and 2019–2021 (OR 4.35; 95% CI 4.30–4.39). By 2019–2021, the percentages of patients filling GLP1RA/SGLT2i in cities, small towns, and remote areas were 18.8%, 18.8%, and 17.4%, respectively. Small town residents had higher odds of fills than those in cities (OR 1.05; 95% CI 1.04–1.06). Older age was associated with lower fill rates; compared to 18–44&#xa0;year olds, odds for those 45–64&#xa0;years were OR 0.88 (95% CI 0.87–0.89), 65–74&#xa0;years: OR 0.48 (95% CI 0.47–0.48), and ≥ 75&#xa0;years: OR 0.17 (95% CI 0.17–0.18). Men were less likely to fill GLP1RA/SGLT2i than women (OR 0.91; 95% CI 0.90–0.92). Presence of ASCVD and CKD were associated with greater odds of filling GLP1RA/SGLT2i (OR 1.03 [95% CI 1.01–1.05] and OR 1.12 [95% CI 1.10–1.14], respectively), while HF was associated with lower odds (OR 0.86 [95% CI 0.85–0.88]).</p> Conclusions <p>GLP1RA and SGLT2i fills increased over time but remained low overall. They were filled more often by younger people, women, those with ASCVD or CKD (but not with HF), and in small towns.</p>

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Fill Patterns of Glucose-Lowering Drugs with Cardiovascular and Kidney Benefits in the Rural and Urban United States, 2012–2021

  • 期刊论文

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  • 发表日期：

    2025年8月4日

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  • Kyle Steiger,
  • Kavya Sindhu Swarna,
  • Jeph Herrin,
  • Rozalina G. McCoy

摘要

Background

Glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and kidney outcomes, but accessibility concerns persist. Whether access is worse in rural communities is unknown.

Objective

To examine fills of GLP1RA/SGLT2i by adults with type 2 diabetes in rural and urban US counties.

Design

Cross-sectional use claims from OptumLabs® Data Warehouse, 2012–2021.

Patients

Adults with type 2 diabetes.

Main Measures

We examined rates and odds of fills of GLP1RA or SGLT2i, adjusting for time period, age, sex, presence of cardiorenal comorbidities (heart failure [HF], atherosclerotic cardiovascular disease [ASCVD], chronic kidney disease stages 3–4 [CKD]), and rurality.

Key Results

The study included 2,579,577 adults with type 2 diabetes (mean age 63.9; 49.6% female). Compared to 2012–2015, fills of GLP1RA/SGLT2i increased in 2016–2018 (OR 2.49; 95% CI 2.47–2.52) and 2019–2021 (OR 4.35; 95% CI 4.30–4.39). By 2019–2021, the percentages of patients filling GLP1RA/SGLT2i in cities, small towns, and remote areas were 18.8%, 18.8%, and 17.4%, respectively. Small town residents had higher odds of fills than those in cities (OR 1.05; 95% CI 1.04–1.06). Older age was associated with lower fill rates; compared to 18–44 year olds, odds for those 45–64 years were OR 0.88 (95% CI 0.87–0.89), 65–74 years: OR 0.48 (95% CI 0.47–0.48), and ≥ 75 years: OR 0.17 (95% CI 0.17–0.18). Men were less likely to fill GLP1RA/SGLT2i than women (OR 0.91; 95% CI 0.90–0.92). Presence of ASCVD and CKD were associated with greater odds of filling GLP1RA/SGLT2i (OR 1.03 [95% CI 1.01–1.05] and OR 1.12 [95% CI 1.10–1.14], respectively), while HF was associated with lower odds (OR 0.86 [95% CI 0.85–0.88]).

Conclusions

GLP1RA and SGLT2i fills increased over time but remained low overall. They were filled more often by younger people, women, those with ASCVD or CKD (but not with HF), and in small towns.