Disparities in GLP-1 receptor agonist prescriptions among breast cancer survivors with type 2 diabetes.

Abstract

e13831 Background: GLP-1 receptor agonists (GLP-1RA) improve glycemic control, promote weight loss, and reduce cardiovascular risks in patients with type 2 diabetes mellitus (DM2). Breast cancer survivors face increased recurrence risk and cardiovascular disease related to obesity and DM2 and thus can have substantial benefits from these agents. However, challenges in access to GLP-1RA exist, and this may exacerbate cancer survivorship care disparities. This study evaluated sociodemographic and geographic disparities in GLP-1RA prescription rates. Methods: We conducted a retrospective cohort analysis utilizing TriNetX, a de-identified electronic health record data platform. Breast cancer patients with DM2 (2005–2024) were included, excluding those with GLP-1RA contraindications (type 1 diabetes, pancreatitis, gastroparesis, thyroid cancer). Patients were stratified by race (Asian, Black, White, Other [American Indian or Pacific Islander] and age (18-64 or ≥65 years) and 1:1 propensity-matched for multiple covariates such as BMI and body weight, cardiometabolic conditions (hypertension, dyslipidemia, ischemic heart disease, obstructive sleep apnea), bariatric surgery, HbA1c, and prior antidiabetic agents. Sensitivity analysis included patients with overweight/obesity (BMI ≥ 25 kg/m2). The primary outcome was the rate of GLP-1RA prescription (lixisenatide, albiglutide, dulaglutide, semaglutide, liraglutide, exenatide, tirzepatide). Cox proportional hazards model estimated Hazard Ratios (HR) to assess time-to-event outcomes. Results: A total of 130,228 patients met eligibility (mean [SD] age: 67.2 [11.9] years; 61.6% White, 21.0% Black, 5.2% Asian, 12.1% Other). The mean follow-up time was 5.7 ± 4.2 years. Amongst the entire study population and those with overweight/obesity, White patients were more likely to be prescribed GLP-1RA compared to Asian, Black, and Other patients (HRs in Table 1). Those aged > 65 were less likely to receive GLP-1RA than younger patients (HR 0.44, 95% CI 0.42–0.46). The most common geographic regions by race were the South for White (38%) and Black (62%) patients, the West for Asian patients (45%), and the Northeast for others (43%). Conclusions: Significant disparities in GLP-1RA prescription rates were identified among breast cancer survivors with DM2, particularly among older adults and non-White racial groups. This emphasizes the need for targeted interventions to improve equitable access to these classes of pharmaceutics with important health benefits in cancer survivors. GLP-1RA prescription disparities by racial subgroups. Race Race Hazard Ratio [95% CI] All Patients (n=130,228) White Ref Asian 0.64 [0.58–0.71] Black 0.78 [0.75–0.81] Other 0.84 [0.75–0.95] Patients with Overweight/Obesity (n=70,716) White Ref Asian 0.78 [0.68–0.88] Black 0.78 [0.74–0.81] Other 0.83 [0.72–0.95]