65-OR: Differences in the Use of Diabetes Medications with Cardiorenal Benefits between Rural and Urban America

Abstract

Rural Americans are more likely than urban Americans to have poorly controlled diabetes and to die from diabetes-related complications. This is due to multiple biopsychosocial factors, including poor access to primary and specialty care. Previous studies found disparities in the use of newer glucose-lowering medications with cardiovascular and renal benefits (GLP-1RA and SGLT2i) by women, Black patients, and low-income patients. Whether there are disparities in the use of GLP-1RA and SGLT2i based on rurality is unknown. Using a de-identified dataset of commercially insured and Medicare Advantage beneficiaries with type 2 diabetes, we examined diabetes medication use across the spectrum of rurality: urban (population >50,000), small town (population 2500-50,000), and rural (population <2500). Patients with type 2 diabetes and vascular disease (rural n=25,684, small town n=147,045, urban n=810,647) were prescribed the preferred GLP-1-RA (rural 6.6%, small town 7.2%, urban 6.5%) and SLGT2i (rural 4.6%, small town 5.3%, urban 4.5%) less often than non-preferred sulfonylureas (rural 28.7%, small town 29%, urban 27.4%). Patients with heart failure (rural n=8,818, small town n=50,489, urban n=247,621) were prescribed preferred SGLT2i (rural 3.7%, small town 4.3%, urban 3.5%) less often than non-preferred DPP4i (rural 10.3%, small town 11.8%, urban 12%) and sulfonylurea (rural 27.4%, small town 27.7%, urban 26.0%). Patients with stages 3-4 chronic kidney disease (rural n=7444, small town n=43,483, urban n=236,982) were prescribed preferred GLP-1-RA (rural 7.6%, small town 8%, urban 7.2%) and SGLT2i (rural 3.4%, small town 3.7%, urban 3.3%) less often than non-preferred sulfonylureas (rural 29.9%, small town 30.8%, urban 30%). Given these data, interventions to improve prescribing of diabetes medications with cardiorenal benefits are needed in all areas of the US. Rural disparities in diabetes outcomes do not appear to be driven by differences in medication use alone. Disclosure K.Steiger: None. K.Swarna: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. R.G.Mccoy: Consultant; Emmi. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)