Three new classes of glucose-lowering drugs were introduced into practice over the past 15 years. DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors have low hypoglycemia risk, do not cause weight gain, and GLP-1RA and SGLT2i have additional cardiovascular and renal benefits. We previously found low rates of early SGLT2i use by women and black patients, but more recent data and data for other drugs were lacking. Using OptumLabs Data Warehouse, a de-identified dataset of commercially-insured and Medicare Advantage beneficiaries, we identified adults with type 2 diabetes who first started a DPP-4i (n=140,933), GLP-1RA (n=107,331), SGLT2i (n=112,892), or any other diabetes drug (n=1,743,484) between 2013-2018. Odds of starting each medication class were examined in separate logistic regression models for white women (WW), non-white men (NM), and non-white women (NW) compared to white men, adjusting for other factors affecting drug choice (Figure). Results were mixed, as depicted by the Figure. Our study design cannot identify the causes of preferential use of DPP-4i among non-white patients, or the preferential avoidance of SGLT2i among women and NM and of GLP-1RA among NW. Because these drugs have important safety and efficacy benefits, our findings call for closer examination of potential implicit biases surrounding medication prescribing and diabetes management.


R.G. McCoy: None. H. Van Houten: None. S.M. Dunlay: None. X. Yao: None. T. Dempsey: None. P. Noseworthy: None. L.R. Sangaralingham: None. A.H. Limper: None. N. Shah: None.


National Institutes of Health (K23DK114497)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at