Newer Treatments and Glycemic Control in US Adults With Diabetes Across Risk Groups, Sex, and Ethnicity: The NIH Precision Medicine Initiative (All Of Us Study)

Abstract Objective: There are limited data on the extent of evidence-based SGLT2is and GLP1-RAs among real-world cohorts of patients with DM. We examined the use of these therapies and glycemic control among current US adults with DM by risk groups, sex, and ethnicity. Methods In adults ≥ 18 years of age with DM from the NIH Precision Medicine Initiative All of Us Study including 340 US sites, we categorized DM groups as 1) low risk with ≤ 1 DM risk factor, 2) high risk with ≥ 2 DM risk factors, and 3) DM with known ASCVD. Risk factors included age > 60 years, hypertension, LDL-C ≥ 160 mg/dL, cigarette smoking, and HDL-C 8%. We also examined the % on SGLT2-i among those with heart failure (HF) or chronic kidney disease (CKD) (eGFR Results Our 42,064 participants with DM included 27.2% non-Hispanic Black and 21.7% Hispanic or Latino; overall 29.5%, 31.2%, and 39.3% were at lower risk, higher risk, or with ASCVD, respectively. Across risk groups, sex and ethnicity, there remains underutilization of SGLT-is and GLP1-RAs, and few people with HF or CKD are on SGLT2i (Table). Conclusions Despite recent guidelines for usage of SGLT2-is or GLP1-RAs among higher risk people with DM, few are actually taking them, and use is overall lower among underserved ethnic groups.