Sex and Socioeconomic Differences in the Initiation of SGLT2 Inhibitors and GLP‐1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study
4 affiliations
- 1Steno Diabetes Center Aarhus, Aarhus University Hospital Aarhus Denmark
- 2Department of Cardiology Aarhus University Hospital Aarhus Denmark
- 3Department of Clinical Medicine, Health Aarhus University Aarhus Denmark
- 4Department of Public Health, Health Aarhus University Aarhus Denmark
Abstract
Aims: Cardioprotective glucose‐lowering drugs (GLDs) remain underutilised in individuals with Type 2 diabetes (T2D) and cardiovascular disease (CVD). We aimed to estimate the association between sex and socioeconomic status and initiation of cardioprotective GLDs and to identify factors associated with non‐initiation of cardioprotective GLDs.
Materials and Methods: Using Danish health registries, we identified individuals with both T2D and CVD between 2015 and 2022. Initiation of cardioprotective GLDs, sodium–glucose co‐transporter‐2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) were assessed by sex and socioeconomic status. We estimated crude cumulative proportions, incidence rates (IR) and adjusted incidence rate ratios (IRR). Risk factors for non‐initiation were analyzed using poisson regression.
Results: Among 81 361 individuals with newly diagnosed concomitant T2D and CVD (37% women), crude initiation rates of GLDs per 1000 person‐years increased with higher educational level. This gradient disappeared after multivariable adjustment, with IRRs for females 0.95 (95% CI: 0.86–1.05) and males 1.00 (95% CI: 0.94–1.07). Marital and occupational status showed clear associations: compared with employed women, IRRs for initiation were 0.81 (95% CI: 0.75–0.88) for unemployed and 0.88 (95% CI: 0.79–0.97) for retired women. Compared with employed men, IRRs for unemployed and retired men were 0.77 (95% CI: 0.73–0.81) and 0.83 (95% CI: 0.78–0.88), respectively. Divorced, widowed and unmarried individuals also had lower IRR than married individuals.
Conclusion: Among individuals with newly diagnosed T2D and CVD, lower initiation of guideline‐recommended cardioprotective GLDs was observed among individuals with low socioeconomic status in both men and women.
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BibTeX
@article{calderon2026socioeconomic,
title = {{Sex and Socioeconomic Differences in the Initiation of SGLT2 Inhibitors and GLP‐1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study}},
author = {Elena Calderon and Lasse Bjerg and Anders A. Isaksen and Annelli Sandbæk and Kristian L. Funck and Erik L. Grove},
journal = {Diabetes, Obesity \& Metabolism},
year = {2026},
month = sep,
doi = {10.1111/dom.71334},
url = {https://doi.org/10.1111/dom.71334},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Sex and Socioeconomic Differences in the Initiation of SGLT2 Inhibitors and GLP‐1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study
AU - Elena Calderon
AU - Lasse Bjerg
AU - Anders A. Isaksen
AU - Annelli Sandbæk
AU - Kristian L. Funck
AU - Erik L. Grove
PY - 2026
DA - 2026/09/20
JO - Diabetes, Obesity & Metabolism
DO - 10.1111/dom.71334
UR - https://doi.org/10.1111/dom.71334
AB - Aims: Cardioprotective glucose‐lowering drugs (GLDs) remain underutilised in individuals with Type 2 diabetes (T2D) and cardiovascular disease (CVD). We aimed to estimate the association between sex and socioeconomic status and initiation of cardioprotective GLDs and to identify factors associated with non‐initiation of cardioprotective GLDs. Materials and Methods: Using Danish health registries, we identified individuals with both T2D and CVD between 2015 and 2022. Initiation of cardioprotective GLDs, sodium–glucose co‐transporter‐2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) were assessed by sex and socioeconomic status. We estimated crude cumulative proportions, incidence rates (IR) and adjusted incidence rate ratios (IRR). Risk factors for non‐initiation were analyzed using poisson regression. Results: Among 81 361 individuals with newly diagnosed concomitant T2D and CVD (37% women), crude initiation rates of GLDs per 1000 person‐years increased with higher educational level. This gradient disappeared after multivariable adjustment, with IRRs for females 0.95 (95% CI: 0.86–1.05) and males 1.00 (95% CI: 0.94–1.07). Marital and occupational status showed clear associations: compared with employed women, IRRs for initiation were 0.81 (95% CI: 0.75–0.88) for unemployed and 0.88 (95% CI: 0.79–0.97) for retired women. Compared with employed men, IRRs for unemployed and retired men were 0.77 (95% CI: 0.73–0.81) and 0.83 (95% CI: 0.78–0.88), respectively. Divorced, widowed and unmarried individuals also had lower IRR than married individuals. Conclusion: Among individuals with newly diagnosed T2D and CVD, lower initiation of guideline‐recommended cardioprotective GLDs was observed among individuals with low socioeconomic status in both men and women.
SN - 1462-8902
SN - 1463-1326
ER -