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Racial Disparities in SGLT2 Inhibitor Initiation Among Medicaid-Insured Adults With Type 2 Diabetes: A Retrospective
Vivian Hsing-Chun Wang1, Sarah Abdul Sabboor2, Jianing Xu3
1Division of Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, New York.
AACE Endocrinology and Diabetes
|July 23, 2026
Summary
Black Medicaid patients with type 2 diabetes (T2DM) are less likely to receive sodium-glucose cotransporter-2 inhibitors (SGLT2is). This delay, especially early in diabetes, may worsen long-term health outcomes.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Nephrology
- Health Services Research
Background:
- Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are crucial for managing type 2 diabetes (T2DM) and preventing cardiovascular and renal complications.
- Socioeconomic factors and prescribing inertia can create barriers to SGLT2i initiation, potentially impacting disadvantaged populations.
- Racial and ethnic disparities in healthcare access and outcomes are a significant concern in T2DM management.
Purpose of the Study:
- To investigate racial and ethnic differences in the initiation of SGLT2 inhibitors among patients with T2DM covered by Medicaid.
- To identify potential disparities in timely access to SGLT2 inhibitors for diverse patient groups.
Main Methods:
- A retrospective cohort study analyzed adult Medicaid patients (18-64) with T2DM prescribed metformin from the MarketScan Multistate Medicaid Database (2015-2022).
- Cox proportional hazards models, adjusted for demographic and clinical factors, were used to assess the time to SGLT2i initiation.
- The study included 13,744 patients, examining initiation rates based on race and ethnicity.
Main Results:
- Non-Hispanic Black patients had an 18% lower rate of SGLT2i initiation compared to non-Hispanic White patients (HR=0.82; 95% CI: 0.75-0.90).
- This disparity was more pronounced in patients without pre-existing cardiovascular disease, heart failure, or chronic kidney disease (HR=0.79; 95% CI: 0.71-0.87).
- No significant racial or ethnic differences in SGLT2i initiation were observed among patients with these specific comorbidities.
Conclusions:
- Significant delays in SGLT2i initiation were observed among Black Medicaid patients, particularly in the early stages of T2DM.
- These delays may increase the risk of long-term diabetes-related complications for this population.
- Targeted interventions addressing structural barriers are essential to promote equitable SGLT2i prescribing and improve diabetes care outcomes.
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