Retrospective, cohort review of pharmacists' impact on disparities in care in the management of type 2 diabetes with glucagon‐like peptide‐1 agonists and sodium glucose co‐transporter 2 inhibitors

Abstract

AbstractBackgroundThe American Diabetes Association recommend glucagon‐like peptide‐1 (GLP‐1) agonists and sodium glucose co‐transporter 2 (SGLT‐2) inhibitors be considered as first‐line therapy for type 2 diabetes. A secondary analysis of the Look AHEAD study determined these agents are disproportionately prescribed at higher rates to White patients compared with Black patients.ObjectivesThe objective of this study is to evaluate if a disparity exists between the prescribing of SGLT‐2 inhibitors and GLP‐1 agonists between White patients and Black patients at an academic, safety‐net health system.MethodsA single‐center retrospective chart review was conducted on patients seen at a pharmacist‐managed or provider‐managed clinic. The primary outcome is the difference in prescribing of SGLT‐2 inhibitors and GLP‐1 agonists between Black and White patients in the pharmacist and provider‐managed group. Secondary outcomes include differences in prescribing in Hispanic patients and patients with a serious mental illness.ResultsThe primary outcome of prescribing rates for GLP‐1 agonists and SGLT‐2 inhibitors did not differ significantly in the pharmacist comanaged group. The primary outcome in the provider managed group did differ significantly. The largest prescribing rate was in the “other” race category. Only two variables were found in the combined datasets to play a role in the prescribing of a GLP‐1 agonist or SGLT‐2 inhibitor. Having only a provider and not a pharmacist involved in care was predictive of not being prescribed either agent (odds ratio = 0.096, P = <.001). Insurance status was the other statistically significant predictor of being prescribed a GLP‐1 agonist or SGLT‐2 inhibitor (odds ratio = 1.592, P = .006).ConclusionA clinically significant difference in prescribing based on race did not exist in the pharmacist comanaged group or the provider only managed group. Pharmacist involvement and insurance status appear to have a positive impact on an SGLT‐2 inhibitor or GLP‐1 agonist being prescribed.