Association of Social Determinants of Health with Utilization of SGLT2 Inhibitors and GLP1 Receptor Agonists: A...

SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) reduce cardiovascular and metabolic risks in type-2 diabetes, cardiovascular disease, and obesity, yet social determinants of health (SDOH) may influence access to these therapies. We conducted a systematic review and meta-analysis to assess whether SDOH-socioeconomic status (SES), insurance status, education, geography, neighborhood deprivation-and demographic characteristics-race and sex-are associated with differential utilization of SGLT2i or GLP-1RA.

Six databases (Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar) were searched through February 2025. Retrospective and cross-sectional studies reporting association between at least one SDOH and prescription of SGLT2i and/or GLP-1RA were included. The primary outcome was the adjusted odds of utilization of SGLT2i, GLP-1RA, or both drugs by SDOH categories. Meta-analyses were conducted separately for SGLT2i and GLP-1RA using random-effects models. Risk of bias was assessed using ROBINS-I.

Twenty-six studies (> 14.6 million patients) were included. Low-SES patients had reduced odds of utilization (aOR 0.73; 95% CI 0.61-0.76). Medicaid (aOR 0.70; 95% CI 0.55-0.89), Medicare (0.68; 0.60-0.78), and Medicare Advantage (aOR 0.41; 95% CI 0.30-0.57) patients had lower odds than privately insured patients. Lower educational attainment (aOR 0.70; 95% CI 0.53-0.93) and rurality (aOR 0.91; 95% CI 0.87-0.95) were associated with reduced utilization. Patients in high-deprivation neighborhoods (aOR 0.80; 95% CI 0.69-0.93) had lower odds of GLP-1RA utilization. Women had lower odds of SGLT2i utilization (aOR 0.89; 95% CI 0.82-0.95), but greater odds of GLP-1RA (aOR 1.33, 1.23-1.43). Black (aOR 0.80; 95% CI 0.79-0.82) patients had reduced utilization of both drugs, while Hispanic (aOR 0.81; 95% CI 0.69-0.96), and Asian (aOR 0.49; 95% CI 0.41-0.58) patients had reduced odds of GLP-1RA.

Disparities in SGLT2i and GLP-1RA utilization span SES, insurance, education, geography, neighborhood deprivation, race, and sex, potentially limiting population-level benefits and warranting interventions to improve access.