Among 1.18 million US diabetes patients, Black, Asian, Hispanic, and lower-income individuals were significantly less likely to be prescribed GLP-1 receptor agonists — even when they had cardiovascular disease and stood to benefit most.
41% less likelyAsian patients with type 2 diabetes were 41% less likely than White patients to be prescribed a GLP-1 receptor agonist, the largest racial disparity observed
What the researchers found
Among 1.18 million commercially insured US patients with type 2 diabetes, only 7.7% received a GLP-1 receptor agonist between 2015 and 2019. Use increased over that period (3.2% to 10.7%), but significant racial and economic disparities persisted. Black patients were 19% less likely to receive a GLP-1 RA (aOR 0.81), Asian patients were 41% less likely (aOR 0.59), and Hispanic patients were 9% less likely (aOR 0.91) compared to White patients.
Higher household income was associated with greater GLP-1 RA use — patients from zip codes with incomes over $100,000 were 13% more likely to receive these drugs than those from areas with incomes below $50,000. Even among patients with established cardiovascular disease — the group most likely to benefit from GLP-1 RAs based on clinical trial evidence — use remained low (2.8% to 9.4%) with similar racial and income disparities.
Why it matters
GLP-1 receptor agonists don't just lower blood sugar — they reduce heart attacks, strokes, and cardiovascular death. Yet the patients who carry the highest burden of cardiovascular disease (Black, Hispanic, and lower-income individuals) are the least likely to receive these drugs. This study quantifies a prescribing gap that could be widening existing health disparities, especially as GLP-1 drugs have become among the most impactful medications in modern medicine.
The numbers in context
n=1,180,260 · 7.7% received GLP-1 RA · use grew 3.2% → 10.7% (2015–2019) · Black aOR 0.81 · Asian aOR 0.59 · Hispanic aOR 0.91 · income >$100K aOR 1.13 · ASCVD subgroup: 2.8% → 9.4%
How the study worked
Retrospective cohort analysis using OptumInsight Clinformatics Data Mart, a large commercial insurance claims database. Included adult patients with type 2 diabetes from October 2015 through June 2019. Multivariable logistic regression models assessed associations between race, ethnicity, sex, zip code-linked income, and GLP-1 RA prescribing. A subgroup analysis focused on patients with established atherosclerotic cardiovascular disease.
Who was studied
1.18 million commercially insured US adults with type 2 diabetes, median age 69, 50.3% female, 57.7% White
What this study cannot tell us
Limited to commercially insured patients, excluding uninsured and Medicaid populations where disparities may be even larger. Race and ethnicity data in claims databases can be imprecise. Zip code-level income is a proxy for individual socioeconomic status. The study captures prescriptions but not adherence or outcomes. Reasons for non-prescribing (cost, patient preference, provider knowledge) were not assessed. Data ended in 2019, before the explosion of GLP-1 RA use driven by weight loss indications.
How to read the evidence
This is a large retrospective cohort study published in JAMA Health Forum using over 1.18 million patients from a national commercial insurance database with multivariable adjustment. The 'Strong' grade reflects the massive sample size, rigorous statistical methods, and the credibility of the data source.
When this study was published
Published in 2021 using data through mid-2019, this study captures GLP-1 prescribing patterns before the weight-loss driven surge in demand. Disparities may have shifted since then as these drugs became more widely known but also more expensive and supply-constrained.
The bigger picture
This study adds GLP-1 agonists to a growing list of cardiovascular drugs where racial and economic disparities in prescribing are well documented. As these drugs have become even more prominent since 2019 — now used for weight loss as well as diabetes — the question of equitable access has become a major public health issue. The findings underscore that drug efficacy in clinical trials means little if the patients who need them most can't access them.
Questions still open
- Have prescribing disparities narrowed or widened since 2019, as GLP-1 drugs became household names?
- Is the disparity driven primarily by cost barriers, provider prescribing patterns, or patient awareness?
- Would expanded insurance coverage or lower drug costs close the racial and income gaps in GLP-1 access?
Common questions
Why would race or income affect whether someone gets prescribed a GLP-1 drug?
Do these disparities still exist now that drugs like Ozempic are so well-known?
Read the original research
Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US.
JAMA health forum, 2(12), e214182
Citation
Eberly, Lauren A; Yang, Lin; Essien, Utibe R; Eneanya, Nwamaka D; Julien, Howard M; Luo, Jing; Nathan, Ashwin S; Khatana, Sameed Ahmed M; Dayoub, Elias J; Fanaroff, Alexander C; Giri, Jay; Groeneveld, Peter W; Adusumalli, Srinath. (2021). Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US.. JAMA health forum, 2(12), e214182. https://doi.org/10.1001/jamahealthforum.2021.4182