Evidence-Based Practice in Prescribing SGLT2i and GLP-1 RA Across Ethnic and Racial Groups: a Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND

The newer classes of anti-diabetes medications have additional cardiovascular and renal effects, and restricted access would contribute to diabetes-related healthcare disparities. Hence, a systematic review, and meta-analysis, was undertaken to determine the existence of racial and ethnic disparities in the uptake of SGLT2i or GLP-1 RA.

METHODS

The search was performed using Scopus, Cochrane Central Registry of Controlled Trials, PubMed, and Web of Science databases. Eligibility to include the studies was assessed independently, and this review included observational studies. The necessary information was extracted using the Cochrane-modified data extraction form. The quality of the studies was assessed using the Newcastle-Ottawa scale. RevMan v5.4.1 was used to conduct the analysis. The certainty of the evidence was measured with GradePro.

RESULTS

The likelihood of prescription fills with SGLT2i and GLP-1 RA was lower among the Black population, with odds ratios (OR) of 0.81 (95% CI 0.75-0.88, p < 0.0001) for SGLT2i and 0.78 (95% CI 0.70-0.87, p < 0.0001) for GLP-1 RA when compared to White population. Additionally, Asian individuals and those classified under "Other" populations had a significant reduction in GLP-1 RA prescription fills, with odds ratios of 0.61 (95% CI 0.43-0.86) and 0.73 (95% CI 0.60-0.89), respectively. However, there was no significant difference in SGLT2i prescription fills among the Asian individuals (p = 0.56) or those in the "Other" population category (p = 0.51).

CONCLUSIONS

The extent of evidence-based practice in prescribing SGLT2i was significantly low among the Black population compared to patients who are Whites. The number of prescriptions filled by GLP-1 RA was significantly low among the Asian population, the Black population, and other populations. Thus, policymakers and clinicians must take the necessary initiatives to achieve pharmacoequity in managing T2DM with co-morbidity conditions.