Disparities in GLP-1RA and SGLT2i Uptake: a Systematic Review and an Equity-First Framework for Cardiovascular-Kidney-Metabolic Care.

In 30 seconds

This systematic review synthesised U.S. evidence on disparities in prescribing and initiation of GLP-1 receptor agonists and SGLT2 inhibitors, and proposed an equity-first framework for cardiovascular-kidney-metabolic care. Across 100 studies published from 2013 to 2026, lower use was frequently reported among Black and Hispanic patients, Medicaid beneficiaries, lower-income populations, and older adults. Uptake increased after landmark trials and guideline updates but remained below the eligible population; disparities persisted or widened for some newer agents. The review identifies barriers across societal, health-system, provider, patient, and therapy-related domains and outlines multilevel strategies to advance equitable access.

Key findings

• The review included 100 U.S. studies published from 2013 to 2026.
• Black and Hispanic patients, Medicaid beneficiaries, lower-income populations, and older adults frequently had lower prescribing or initiation.
• Use rose after landmark trials and guideline updates but remained well below the eligible population; disparities persisted or widened for some newer agents.
• Geographic and sex-related patterns were more heterogeneous than disparities associated with race and ethnicity, socioeconomic status, insurance, age, and specialty-care access.

Why it matters

These therapies are described as improving cardiovascular, kidney, and metabolic outcomes, yet the review finds that access is uneven across patient groups. Recognising disparities across multiple levels of care can help health systems and clinicians identify where eligible patients may be missed and inform coordinated efforts to monitor and address barriers.

What to keep in mind

The abstract does not report study-level methods or quality assessments, and the included evidence is limited to U.S. studies.