MON-826 Impact Of Demographic And Social Determinants On Access To SGLT2 Inhibitors And GLP-1 Receptor Agonists: A Systematic Review And Meta-Analysis

Abstract Disclosure: N. Shah: None. J. Edjimbi: None. A. Grimshaw: None. C. Gunderson: None. S. Gupta: None. Sodium–glucose cotransporter2 inhibitors (SGLT2i) and glucagonlike peptide1 receptor agonists (GLP1RA) are established treatments for type 2 diabetes mellitus (DM), obesity, and cardiovascular disease; however, significant disparities in their prescription persist. To date, no systematic review or metaanalysis has evaluated the impact of demographics and social determinants of health (SDOH) on utilization patterns for these agents. We hypothesized that among adults with DM, those from racial minority groups, of female sex, in the lowest income strata, or with public insurance would have lower odds of receiving SGLT2i and GLP1RA compared with white, male, higherincome, and commercially insured counterparts. To test this, we conducted a comprehensive search of the Cochrane Library, Google Scholar, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection for observational studies reporting adjusted odds ratios (aORs) for prescribing across these demographic and SDOH characteristics. Our search yielded over 8,100 records, of which 21 studies (study years 2016-2025; regions: US, United Kingdom, Netherlands, South Korea, Canada, Australia) directly compared SGLT2i and GLP1RA prescribing across these demographic and social-determinant characteristics. We extracted studyspecific aORs and 95% confidence intervals (CIs) for each drug class and pooled them separately using DerSimonian–Laird randomeffects models. Heterogeneity was assessed with I² statistics. Among 7,340,058 patients in 21 studies, 47.2% were female, 55.2% white, mean/median age 60–74.9 years, 28.8% lowest-income, and 45.4% publicly insured. For SGLT2i, pooled analyses showed lower odds among black patients (aOR 0.71, 95% CI 0.51–0.99; I² = 99.8%); female patients (0.89, 0.82–0.95; I² = 99.2%); low-income patients (0.96, 0.92–1.00; I² = 96.7%); and patients with Medicare (0.68, 0.60–0.78; I² = 52.7%) or Medicare Advantage (0.41, 0.30–0.57; I² = 99.8%). For GLP-1RA, lower odds were seen in black patients (0.73, 0.57–0.94; I² = 99.3%), Hispanic patients (0.81, 0.69–0.96; I² = 98.6%), and Asian patients (0.49, 0.41–0.58; I² = 96.7%); low-income patients (0.86, 0.81–0.92; I² = 96.4%); and patients with Medicaid (0.70, 0.55–0.89; I² = 73.4%), Medicare (0.73, 0.55–0.96; I² = 92.0%), or Medicare Advantage (0.49, 0.36–0.68; I² = 99.6%), whereas female patients had higher odds (1.33, 1.23–1.43; I² = 96.1%). These results reveal prescribing disparities across race, sex, income, and insurance status, with minority groups, lowincome, and publicly insured patients with DM less likely to receive SGLT2i or GLP1RA. Further research should elucidate the mechanisms driving these differences and evaluate interventions to promote equitable use of these therapies. Presentation: Monday, July 14, 2025

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