Auzanneau, Marie

Gölz, Stefan

Haak, Thomas

Holl, Reinhard W.

Hugenberg, Inge

Pavel, Marianne

Rosenbauer, Joachim

Seufert, Jochen

Zeyfang, Andrej

Zimny, Stefan

Diabetes Obesity and Metabolism

OPEN FAU Online-Publikationssystem der Friedrich-Alexander-Universität Erlangen-Nürnberg

Regional socioeconomic deprivation associated with the use of sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists in adults with type 2 diabetes in Germany

Cardiovascular disease (CVD) is still the leading cause of mortality in people with diabetes.1 However, remarkable advances in the management of cardiovascular prevention and treatment have been made in the past decade due to the availability of newer glucose-lowering agents. Sodium-glucose cotransporter-2 (SGLT2) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) are now broadly recommended for people with type 2 diabetes (T2D) and cardiovascular or renal disease, heart failure or high cardiovascular risk.2, 3 However, despite strong evidence of benefits, the use of these newer glucose-lowering medications remains globally suboptimal.4, 5 A number of real-world studies indicate that the use of these substances is regionally variable and often not in line with current guidelines.4-6 A population-based study reported that, in 2020–2021 in Sweden, only 25% to 34% of patients with T2D received SGLT2 inhibitors or GLP-1RAs as recommended.6In many countries, the use of these antidiabetic agents is strongly associated with socioeconomic factors.3, 6-10 For example, studies from Israel, Australia, Denmark, the United Kingdom and the United States report a significantly lower use of GLP-1RAs3, 7, 8, 10, 11 or SGLT2 inhibitors3, 7-9, 11 in people who live in socioeconomically disadvantaged areas, have low income and education level, or belong to racial/ethnic minorities. Because CVD affects people of lower socioeconomic status more frequently,12 this fact represents a major public health problem. Socioeconomic inequities in access to these new medications are expected to increase socioeconomic disparities in cardiovascular morbidity and mortality.8Indeed, the high cost of these medications may partly limit their use.3, 4 For instance, SGLT2 inhibitors and GLP-1RAs tend to be used more frequently in countries with greater economic resources.4 Moreover, in countries without universal healthcare coverage, such as in the United States, insufficient health insurance may limit access to these newer agents.3, 8 However, socioeconomic disparities in the use of these medications have also been described in countries with a universal healthcare system, such as Sweden, Denmark or Israel.6, 7, 9 Therefore, these disparities cannot be explained by cost reimbursement alone.5 They are probably driven by some deeper structural factors that should be investigated.5 Before conducting this investigation, we need to verify if this association between socioeconomic factors and the use of these newer agents also exists in other countries with comprehensive insurance coverage.To date, it remains unclear whether this association also exists in Germany, the most populous country in Europe. Using data from a multicentre population-based registry, we therefore examined if and to what extent demographic and regional socioeconomic factors are associated with the use of these medications in adults with T2D in Germany

Holl, Reinhard

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Regional socioeconomic deprivation associated with the use of sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists in adults with type 2 diabetes in Germany

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