Sex and Socioeconomic Differences in the Initiation of SGLT2 Inhibitors and GLP ‐1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study

Abstract

ABSTRACT Aims Cardioprotective glucose‐lowering drugs (GLDs) remain underutilised in individuals with Type 2 diabetes (T2D) and cardiovascular disease (CVD). We aimed to estimate the association between sex and socioeconomic status and initiation of cardioprotective GLDs and to identify factors associated with non‐initiation of cardioprotective GLDs. Materials and Methods Using Danish health registries, we identified individuals with both T2D and CVD between 2015 and 2022. Initiation of cardioprotective GLDs, sodium–glucose co‐transporter‐2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) were assessed by sex and socioeconomic status. We estimated crude cumulative proportions, incidence rates (IR) and adjusted incidence rate ratios (IRR). Risk factors for non‐initiation were analyzed using poisson regression. Results Among 81 361 individuals with newly diagnosed concomitant T2D and CVD (37% women), crude initiation rates of GLDs per 1000 person‐years increased with higher educational level. This gradient disappeared after multivariable adjustment, with IRRs for females 0.95 (95% CI: 0.86–1.05) and males 1.00 (95% CI: 0.94–1.07). Marital and occupational status showed clear associations: compared with employed women, IRRs for initiation were 0.81 (95% CI: 0.75–0.88) for unemployed and 0.88 (95% CI: 0.79–0.97) for retired women. Compared with employed men, IRRs for unemployed and retired men were 0.77 (95% CI: 0.73–0.81) and 0.83 (95% CI: 0.78–0.88), respectively. Divorced, widowed and unmarried individuals also had lower IRR than married individuals. Conclusion Among individuals with newly diagnosed T2D and CVD, lower initiation of guideline‐recommended cardioprotective GLDs was observed among individuals with low socioeconomic status in both men and women.

The authors' abstract, as published at the source. Diabetes Obesity and Metabolism, 2026 · DOI ↗