Diabetes careDec 5, 2025

Understanding Why Some Medicare Patients Start Using New Diabetes Medications

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jun 27, 2026

Abstract

Essence

Older Medicare beneficiaries with type 2 diabetes from minoritized or socioeconomically disadvantaged groups were less likely to start semaglutide or tirzepatide.

Evidence

This cross-sectional analysis used 100% of Medicare claims for 13,922,387 patients aged 65 years or older with T2DM and found 673,776 initiations in 2023, with lower adjusted odds for non-Hispanic Black versus White patients, dual enrollment, and residence in the most socially vulnerable neighborhoods.

Caveat

Claims-based cross-sectional associations cannot show why initiation differed or whether clinical need, access, prescribing, coverage, or patient preference drove the gaps.

Simplified

OBJECTIVE: Identifying social and economic factors associated with initiation of semaglutide or tirzepatide may inform strategies to support equitable uptake.

RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted using 100% of Medicare claims of patients ≥65 years with type 2 diabetes mellitus (T2DM). The outcome was initiation of semaglutide or tirzepatide. We calculated adjusted odds ratios (aORs) for each exposure (self-reported race/ethnicity, dual enrollment in Medicare and Medicaid, rurality, and social vulnerability index), accounting for demographic and clinical characteristics.

RESULTS: Among 13,922,387 patients with T2DM, 673,776 (4.8%) initiated semaglutide or tirzepatide in 2023. Minoritized racial/ethnic identity (e.g., non-Hispanic Black compared with White; aOR 0.72; 95% CI 0.71-0.72), dual enrollment (aOR 0.90; 0.89-0.91), and residence in the most versus least vulnerable socially vulnerable neighborhoods (aOR 0.93; 0.92-0.93) were associated with lower initiation.

CONCLUSIONS: Minoritized racial/ethnic identity and adverse socioeconomic factors were associated with lower odds of initiation among Medicare beneficiaries with T2DM.