Kaiser Permanente study finds people from most racial and ethnic minority groups less likely to receive newer, safer types of medications
Newer types of medication used to treat type 2 diabetes have dual benefits: they keep blood sugar levels stable, and they reduce the risk of heart and kidney disease — known complications of diabetes. But a new Kaiser Permanente study shows there are racial and ethnic disparities in who is likely to use these medications.
The study, which evaluated pharmacy dispensing in 6 health care organizations throughout the country, found that patients from certain racial and ethnic groups are less likely than white patients to be provided these new diabetes medications. The findings were presented on March 19 at the American Heart Association Epidemiology/Lifestyle Scientific Sessions 2024.
“Our study underscores the need for increasing efforts to ensure more equitable use of new medications across all racial and ethnic groups,” said senior author Julie Schmittdiel, PhD, the associate director of Health Care Delivery and Policy at the Kaiser Permanente Division of Research.
The study included 687,165 adults with type 2 diabetes seen in 6 different health care organizations across the United States from 2014 to 2022. The researchers looked at prescriptions filled for 2 types of medications — SGLT2 inhibitors and GLP-1 receptor agonists — that began to be routinely prescribed in 2019. They include SGLT2 inhibitors such as Jardiance (empagliflozin) and Farxiga (dapagliflozin) and GLP-1 receptor agonists such as Ozempic (semaglutide) and Byetta (exenatide).
The study found that American Indian/Alaska Native, Black, and Hispanic patients were less likely to receive a SGLT2 inhibitor than white patients. In addition, American Indian/Alaska Native, Asian, Black, Hawaiian or Pacific Islander, and Hispanic patients were less likely to receive a GLP-1 receptor agonist than white patients. These racial and ethnic inequities persisted even after the researchers took into account factors such as demographics, diabetes control, diabetes duration and management, additional health problems, and visits to specialists.
The 6 health care organizations studied are part of the Health Care Systems Research Network and include Geisinger in Pennsylvania, HealthPartners in Minnesota and Wisconsin, Henry Ford Health in Michigan, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and Kaiser Permanente Hawaii. The researchers did not compare differences among the health organizations.
The research team said future studies should aim to identify factors that might influence who receives these medications. “It’s possible that not all patients have equal access to information about these medications, or that not all patients are equally comfortable asking their doctors about them,” said lead author Luis A. Rodriguez, PhD, a research scientist, at the Division of Research. “We also don’t know if the cost of the new medications contributed to what we found, or if some patients prefer to keep taking a pill rather than switch to some of the GLP-1 receptor agonists that are self-injectable medications. We need to learn more about why this is happening.”
The study was supported by the Patient-Centered Outcomes Research Institute (PCORI) and National Institute of Diabetes and Digestive and Kidney Diseases.
Co-authors include Holly Finertie, MPH, Andrew Karter, PhD, and Romain S. Neugebauer, PhD, of the Division of Research; Bennett Gosiker, MHS, of the Kaiser Permanente School of Medicine; Tainayah W. Thomas, PhD, MPH, of Stanford University; Lisa K. Gilliam, MD, of The Permanente Medical Group; Caryn Oshiro, PhD, of Kaiser Permanente Hawaii; Jaejin An, PhD, of Kaiser Permanente Southern California; Gregg Simonson, PhD, of the HealthPartners Institute; Andrea E. Cassidy-Bushrow, PhD, of Henry Ford Health System; Sarah K. Dombrowski, PharmD, Geisinger; and Margaret B. Nolan, MD, MS, and Patrick O’Connor, MD, MA, MPH, of the HealthPartners Institute for Medical Education and Research.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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