Journal of general internal medicineMar 16, 2026

How Social Factors Relate to Use of SGLT2 Inhibitors and GLP1 Receptor Agonists

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jun 28, 2026

Abstract

Essence

This meta-analysis found that social and demographic disadvantage was linked to lower use of SGLT2 inhibitors and GLP-1 receptor agonists.

Evidence

This systematic review and meta-analysis of 26 retrospective and cross-sectional studies covering more than 14.6 million patients found lower adjusted odds of use by low socioeconomic status, public insurance, lower education, rurality, neighborhood deprivation, and several racial groups, with sex differences varying by drug class.

Caveat

Because the evidence comes from observational prescribing studies, it shows disparities in utilization but cannot establish why those differences occurred.

Simplified

BACKGROUND: SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) reduce cardiovascular and metabolic risks in type-2 diabetes, cardiovascular disease, and obesity, yet social determinants of health (SDOH) may influence access to these therapies. We conducted a systematic review and meta-analysis to assess whether SDOH-socioeconomic status (SES), insurance status, education, geography, neighborhood deprivation-and demographic characteristics-race and sex-are associated with differential utilization of SGLT2i or GLP-1RA.

METHODS: Six databases (Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar) were searched through February 2025. Retrospective and cross-sectional studies reporting association between at least one SDOH and prescription of SGLT2i and/or GLP-1RA were included. The primary outcome was the adjusted odds of utilization of SGLT2i, GLP-1RA, or both drugs by SDOH categories. Meta-analyses were conducted separately for SGLT2i and GLP-1RA using random-effects models. Risk of bias was assessed using ROBINS-I.

RESULTS: Twenty-six studies (> 14.6 million patients) were included. Low-SES patients had reduced odds of utilization (aOR 0.73; 95% CI 0.61-0.76). Medicaid (aOR 0.70; 95% CI 0.55-0.89), Medicare (0.68; 0.60-0.78), and Medicare Advantage (aOR 0.41; 95% CI 0.30-0.57) patients had lower odds than privately insured patients. Lower educational attainment (aOR 0.70; 95% CI 0.53-0.93) and rurality (aOR 0.91; 95% CI 0.87-0.95) were associated with reduced utilization. Patients in high-deprivation neighborhoods (aOR 0.80; 95% CI 0.69-0.93) had lower odds of GLP-1RA utilization. Women had lower odds of SGLT2i utilization (aOR 0.89; 95% CI 0.82-0.95), but greater odds of GLP-1RA (aOR 1.33, 1.23-1.43). Black (aOR 0.80; 95% CI 0.79-0.82) patients had reduced utilization of both drugs, while Hispanic (aOR 0.81; 95% CI 0.69-0.96), and Asian (aOR 0.49; 95% CI 0.41-0.58) patients had reduced odds of GLP-1RA.

DISCUSSION: Disparities in SGLT2i and GLP-1RA utilization span SES, insurance, education, geography, neighborhood deprivation, race, and sex, potentially limiting population-level benefits and warranting interventions to improve access.