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Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study

BACKGROUND: Low socioeconomic position may affect initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucacon-like-peptide-1 receptor agonists (GLP-1RA) among patients with type 2 diabetes (T2D). We examined the association between socioeconomic position and initiation of SGLT-2i...

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Autores principales: Falkentoft, Alexander C., Andersen, Julie, Malik, Mariam Elmegaard, Selmer, Christian, Gæde, Peter Haulund, Staehr, Peter Bisgaard, Hlatky, Mark A., Fosbøl, Emil, Køber, Lars, Torp-Pedersen, Christian, Gislason, Gunnar H., Gerds, Thomas Alexander, Schou, Morten, Bruun, Niels E., Ruwald, Anne-Christine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802041/
https://www.ncbi.nlm.nih.gov/pubmed/35146474
http://dx.doi.org/10.1016/j.lanepe.2022.100308
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author Falkentoft, Alexander C.
Andersen, Julie
Malik, Mariam Elmegaard
Selmer, Christian
Gæde, Peter Haulund
Staehr, Peter Bisgaard
Hlatky, Mark A.
Fosbøl, Emil
Køber, Lars
Torp-Pedersen, Christian
Gislason, Gunnar H.
Gerds, Thomas Alexander
Schou, Morten
Bruun, Niels E.
Ruwald, Anne-Christine
author_facet Falkentoft, Alexander C.
Andersen, Julie
Malik, Mariam Elmegaard
Selmer, Christian
Gæde, Peter Haulund
Staehr, Peter Bisgaard
Hlatky, Mark A.
Fosbøl, Emil
Køber, Lars
Torp-Pedersen, Christian
Gislason, Gunnar H.
Gerds, Thomas Alexander
Schou, Morten
Bruun, Niels E.
Ruwald, Anne-Christine
author_sort Falkentoft, Alexander C.
collection PubMed
description BACKGROUND: Low socioeconomic position may affect initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucacon-like-peptide-1 receptor agonists (GLP-1RA) among patients with type 2 diabetes (T2D). We examined the association between socioeconomic position and initiation of SGLT-2i or GLP-1RA in patients with T2D at time of first intensification of antidiabetic treatment. METHODS: Through nationwide registers, we identified all Danish patients on metformin who initiated second-line add-on therapy between December 10, 2012, and December 31, 2020. For each time period (2012-2014, 2015-2017, and 2018-2020), we used multivariable multinomial logistic regression to associate disposable income, as proxy for socioeconomic position, with the probability of initiating a specific second-line treatment at time of first intensification. We reported probabilities standardised to the distribution of demographics and comorbidities of patients included in the last period (2018-2020). FINDINGS: We included 48915 patients (median age 62 years; 61·7% men). In each time period, high-income patients were more often men and had less comorbidities as compared with low income-patients. In each time period, the standardised probability of initiating a SGLT-2i or a GLP-1RA was significantly higher in the highest income group compared with the lowest: 11·4% vs. 9·5% (probability ratio [PR] 1·21, 95 % confidence interval [CI] 1·01-1·44) in 2012-2014; 22·6% vs. 19.6% (PR 1·15, CI 1·05-1·27) in 2015-2017; and 65·8% vs. 54·8% (PR 1·20, CI 1·16-1·24) in 2018-2020. The differences by income were consistent across multiple subgroups. INTERPRETATION: Despite a universal healthcare system, low socioeconomic position was consistently associated with a lower probability of initiating a SGLT-2i or a GLP-1RA. These disparities may widen the future socioeconomic gap in cardiovascular outcomes. FUNDING: The work was funded by unrestricted grants from ‘Region Sjaelland Den Sundhedsvidenskabelige Forskningsfond’ and ‘Murermester Lauritz Peter Christensen og hustru Kirsten Sigrid Christensens Fond’.
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spelling pubmed-88020412022-02-09 Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study Falkentoft, Alexander C. Andersen, Julie Malik, Mariam Elmegaard Selmer, Christian Gæde, Peter Haulund Staehr, Peter Bisgaard Hlatky, Mark A. Fosbøl, Emil Køber, Lars Torp-Pedersen, Christian Gislason, Gunnar H. Gerds, Thomas Alexander Schou, Morten Bruun, Niels E. Ruwald, Anne-Christine Lancet Reg Health Eur Articles BACKGROUND: Low socioeconomic position may affect initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucacon-like-peptide-1 receptor agonists (GLP-1RA) among patients with type 2 diabetes (T2D). We examined the association between socioeconomic position and initiation of SGLT-2i or GLP-1RA in patients with T2D at time of first intensification of antidiabetic treatment. METHODS: Through nationwide registers, we identified all Danish patients on metformin who initiated second-line add-on therapy between December 10, 2012, and December 31, 2020. For each time period (2012-2014, 2015-2017, and 2018-2020), we used multivariable multinomial logistic regression to associate disposable income, as proxy for socioeconomic position, with the probability of initiating a specific second-line treatment at time of first intensification. We reported probabilities standardised to the distribution of demographics and comorbidities of patients included in the last period (2018-2020). FINDINGS: We included 48915 patients (median age 62 years; 61·7% men). In each time period, high-income patients were more often men and had less comorbidities as compared with low income-patients. In each time period, the standardised probability of initiating a SGLT-2i or a GLP-1RA was significantly higher in the highest income group compared with the lowest: 11·4% vs. 9·5% (probability ratio [PR] 1·21, 95 % confidence interval [CI] 1·01-1·44) in 2012-2014; 22·6% vs. 19.6% (PR 1·15, CI 1·05-1·27) in 2015-2017; and 65·8% vs. 54·8% (PR 1·20, CI 1·16-1·24) in 2018-2020. The differences by income were consistent across multiple subgroups. INTERPRETATION: Despite a universal healthcare system, low socioeconomic position was consistently associated with a lower probability of initiating a SGLT-2i or a GLP-1RA. These disparities may widen the future socioeconomic gap in cardiovascular outcomes. FUNDING: The work was funded by unrestricted grants from ‘Region Sjaelland Den Sundhedsvidenskabelige Forskningsfond’ and ‘Murermester Lauritz Peter Christensen og hustru Kirsten Sigrid Christensens Fond’. Elsevier 2022-01-25 /pmc/articles/PMC8802041/ /pubmed/35146474 http://dx.doi.org/10.1016/j.lanepe.2022.100308 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Falkentoft, Alexander C.
Andersen, Julie
Malik, Mariam Elmegaard
Selmer, Christian
Gæde, Peter Haulund
Staehr, Peter Bisgaard
Hlatky, Mark A.
Fosbøl, Emil
Køber, Lars
Torp-Pedersen, Christian
Gislason, Gunnar H.
Gerds, Thomas Alexander
Schou, Morten
Bruun, Niels E.
Ruwald, Anne-Christine
Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study
title Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study
title_full Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study
title_fullStr Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study
title_full_unstemmed Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study
title_short Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes – a Danish nationwide observational study
title_sort impact of socioeconomic position on initiation of sglt-2 inhibitors or glp-1 receptor agonists in patients with type 2 diabetes – a danish nationwide observational study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802041/
https://www.ncbi.nlm.nih.gov/pubmed/35146474
http://dx.doi.org/10.1016/j.lanepe.2022.100308
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