Black Veterans with type 2 diabetes and coronary artery disease were 15% less likely to receive evidence-based GLP-1 receptor agonist prescriptions than White Veterans in the VA system, even though SGLT2 inhibitor prescribing showed no racial disparity.
15% lower odds for Black VeteransBlack Veterans with type 2 diabetes and heart disease were significantly less likely to receive evidence-based GLP-1 receptor agonist prescriptions than White Veterans in the VA system (adjusted OR 0.85).
What the researchers found
Among 63,561 Veterans with type 2 diabetes and coronary artery disease across 84 VA medical centers (2015-2023), Black Veterans were 15% less likely to receive evidence-based GLP-1 receptor agonist prescriptions compared to White Veterans (adjusted OR 0.85, 95% CI 0.74-0.98, p=0.025).
No racial disparity was found for SGLT2 inhibitor prescribing (adjusted OR 0.96, 95% CI 0.89-1.04, p=0.32). However, overall uptake remained low for both drug classes: only 42% of eligible patients received SGLT2 inhibitors and 15% received GLP-1RAs by 2023, indicating widespread undertreatment regardless of race.
Why it matters
GLP-1 receptor agonists have proven cardiovascular benefits for patients with type 2 diabetes and heart disease. Finding that Black Veterans are less likely to receive these medications — even in the VA system, which has fewer economic barriers than private healthcare — suggests systemic factors beyond cost are driving the disparity. Addressing this gap could improve cardiovascular outcomes for an underserved population.
How the study worked
Retrospective cohort study using data from the VA Clinical Assessment, Reporting, and Tracking Program across 84 VA medical centers from 2015 to 2023. Researchers identified Veterans with type 2 diabetes and angiographically confirmed coronary artery disease who met eligibility criteria modeled on the EMPA-REG OUTCOME trial (for SGLT2i) or the LEADER trial (for GLP-1RA). Multivariable logistic regression estimated adjusted odds of receiving trial-concordant prescriptions by self-identified race.
What this study cannot tell us
The study was limited to the VA healthcare system, which may not be generalizable to other settings. Self-identified race was used as the exposure variable, which doesn't capture the full complexity of racial identity or structural racism. The study could not determine the specific reasons for the prescribing disparity (e.g., provider bias, patient preference, clinical factors). Residual confounding is possible despite multivariable adjustment.
How to read the evidence
This is a large retrospective cohort study using real-world data from 84 VA medical centers over 8 years. The sample size is robust and the analysis adjusts for multiple confounders, though the observational design limits causal inference.
When this study was published
Published in 2025 using data through 2023, this study captures the most recent era of GLP-1RA and SGLT2i adoption in the VA system.
The bigger picture
This study adds to growing evidence of racial disparities in the prescribing of newer cardiovascular medications. As GLP-1 receptor agonists become increasingly important in managing cardiometabolic disease, ensuring equitable access is critical. The finding that the disparity is drug class-specific (present for GLP-1RAs but not SGLT2 inhibitors) suggests targeted interventions may be needed rather than blanket approaches to prescribing equity.
Questions still open
- What specific factors drive the GLP-1RA prescribing disparity when SGLT2 inhibitors show no racial gap?
- Would targeted prescribing interventions at the VA level reduce this disparity?
- Do similar drug class-specific racial disparities exist in non-VA healthcare systems where economic barriers are greater?
Common questions
Why are GLP-1 receptor agonists important for people with diabetes and heart disease?
Why might Black patients receive fewer GLP-1RA prescriptions even in the VA system?
Read the original research
Evidence-based SGLT2 inhibitor and GLP-1 receptor agonist use by race in the VA healthcare system.
American journal of preventive cardiology, 22, 100966
Citation
Bolden, Demetria M; Richardson, Vanessa; Salahuddin, Taufiq; Henderson, Kamal; Hess, Paul L; Raghavan, Sridharan; Saxon, David R; Ho, P Michael; Waldo, Stephen W; Schwartz, Gregory G. (2025). Evidence-based SGLT2 inhibitor and GLP-1 receptor agonist use by race in the VA healthcare system.. American journal of preventive cardiology, 22, 100966. https://doi.org/10.1016/j.ajpc.2025.100966