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Abstract: SA-PO031

Interaction of Race and Treatment with GLP1-RA, SGLT2i, and Insulin on Mortality in Veterans with Type 2 Diabetes Mellitus (T2DM) and CKD

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Sammons, Stephen R., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Takyi, Augustine, University of Utah Health, Salt Lake City, Utah, United States
  • Kim, David, University of Utah Health, Salt Lake City, Utah, United States
  • Bissada, George, University of Utah Health, Salt Lake City, Utah, United States
  • Wei, Guo, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Singh, Ravinder, University of Utah Health, Salt Lake City, Utah, United States
  • Boucher, Robert E., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Sarwal, Amara, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Hartsell, Sydney Elizabeth, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
Background

Racial disparities in the use of anti-glycemic medications have been reported but it is unclear whether there is an interaction between diabetic medications and race on mortality.

Methods

In an active comparator, new user design study of veterans (N = 30165 ) with T2D with CKD (eGFR < 60) on metformin who then initiated on IG or SGLT2i or GLP1-RA for the first time between 01/01/2018 to 12/31/2021, we 1. examined racial disparities in initiation of these agents and 2. the mortality associations of each of these agents with Black, White and Other races.

Results

Mean age was 71 years, mean baseline eGFR 49.5 ml/min/1.73m2. Compared to White veterans, Black veterans were less likely to be prescribed GLP1-RA's (OR 0.69, CI 0.63-0.77), were more likely to be prescribed insulin glargine (OR 1.11, CI 1.04-1.19), and were similarly prescribed SGLT2i's (OR 1.05, CI 0.99-1.12). There were 4,660 deaths over 80,043 patient-years in the entire cohort. Compared to GLP1RA, insulin glargine was associated with increased mortality in both Blacks and Whites (Figure)

Conclusion

Even though there are racial disparities in prescription of insulin glargine, race does not appear to modify the increased mortality associated with insulin glargine compared to GLP1RA.

Funding

  • Veterans Affairs Support