Kidney Week

Abstract: SA-PO0965

Heterogeneity in Prescribing RAS Inhibitors and SGLT2 Inhibitors/GLP-1 Receptor Agonists for Hispanic/Latino Individuals with Diabetes Based on Heritage Background

Session Information

• Diversity and Equity in Kidney Health
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Sinclair, Matthew R., Duke University School of Medicine, Durham, North Carolina, United States

Matthew R. Sinclair, MD, FASN

• Quijano Angarita, Alvaro Clemente, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States

Alvaro Clemente Quijano Angarita, MSc

• Sotres-Alvarez, Daniela, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States

Daniela Sotres-Alvarez

• Wyatt, Christina M., Duke University School of Medicine, Durham, North Carolina, United States

Christina M. Wyatt, MD

• Corsino, Leonor, Duke University School of Medicine, Durham, North Carolina, United States

Leonor Corsino, MD, MHS

• Diamantidis, Clarissa Jonas, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Clarissa Jonas Diamantidis, MD, MS, FASN

Background

Hispanic/Latino individuals (Hispanics) with diabetes are disproportionately burdened by CKD progression, leading to faster kidney function decline compared to their non-Hispanic White counterparts. Renin-angiotensin system inhibitors (RASi), sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA), improve renal and cardiovascular outcomes, but their use remains suboptimal among Hispanics. Since Hispanics are often analyzed as a single group despite substantial heterogeneity, we examined differences in use of guideline-directed medical therapy (GDMT) across Hispanic heritage backgrounds.

Methods

We analyzed Visit 3 (2020–2024) data from participants with diabetes (N=2,558) aged 28-89 yrs from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a US multicenter observational cohort designed to identify risks and protective factors. Diabetes was defined based on ADA lab criteria and self-reported antidiabetic medication use. We estimated age-adjusted prevalences for RASi and SGLT2i/GLP-1 RA use and multivariable associations using complex logistic regression models adjusting by potential confounders and accounting for complex sampling design.

Results

Overall, mean age was 60.1 years, 50.4% were women, 87.4% had overweight or obesity, and 86% had insurance. RASi use was 49.3% (95% CI 46.2–52.3) and SGLT2i/GLP-1 RA use was 13.0% (95% CI 11.1–14.8). Insured individuals were more than twice as likely as uninsured individuals to use RASi (OR 2.23, 95% CI 1.40–3.54) and SGLT2i/GLP-1 RA (OR 2.10, 95% CI 1.21–3.63). SGLT2i/GLP-1 RA use increased with worsening glycemic control (6.5% with HbA1c <6.5% vs 25.3% with HbA1c >8.0%; p<0.01). Heritage-level disparities were observed, with Cuban (OR 0.35, 95% CI 0.13–0.94) and Central American (OR 0.41, 95% CI 0.18–0.94) individuals having lower odds of SGLT2i/GLP-1 RA use. RASi use increased with age (17.1% in ages 28–44 vs 67.0% in ages 75–89, p<0.01), while SGLT2i/GLP-1 RA use did not differ by age (p=0.36). CKD status was not associated with use of either medication class.

Conclusion

In this diverse cohort of Hispanic adults with diabetes, use of GDMT was low and patterned by insurance access and Hispanic heritage background rather than CKD burden. Disaggregating Hispanic background revealed actionable inequities that may be masked in aggregated analyses.