(B-030) Social Determinants of Health and Disparities in GLP-1 Therapy Access Among Type 2 Diabetes Patients with Stage 2 CKM: Insights from NHANES Data

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome encompasses interconnected conditions such as type 2 diabetes (T2D), hypertension (HTN), hypertriglyceridemia (HTG), metabolic syndrome (MetS), and chronic kidney disease (CKD). As CKM progresses from Stage 2 to Stage 3, patients face escalating risks of cardiovascular and renal complications. GLP-1 receptor agonists, originally approved for T2D management, have demonstrated cardiorenal and cardiometabolic benefits, offering an opportunity to slow CKM progression. However, disparities in access to GLP-1 therapy driven by social determinants of health (SDOH) and varied comorbidities of Stage 2 CKM may limit their potential impact, particularly for underserved populations.

Objectives: To evaluate the influence of SDOH on access to GLP-1 therapy among patients with T2D.

Methods: This cross-sectional study used nationally representative data from the U.S. National Health and Nutrition Examination Survey (NHANES), 2005–2020. The study population included adults with T2D and had ≥1 Stage 2 CKM condition, including HTN, HTG, MetS, or CKD. The primary exposure was SDOH, categorized by Healthy People 2030 domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. GLP-1 therapy usage was analyzed as primary outcome across patient subgroups stratified by demographic and SDOH factors. Proportion tables and heatmaps were used to illustrate disparities in GLP-1 use.

Results: Among participants with T2D and who might have additional conditions of Stage 2 CKM , the mean age was 63.5 years, 48.0% were women, and 28.5% self-identified as non-Hispanic Black. The mean and median of GLP-1 use among individuals with Stage 2 CKM (T2D + ≥1 CKM condition) was 3.2%, and 2.4%, respectively. Across all conditions, individuals without a routine place for healthcare had 0% GLP-1 use across all subtypes of Stage 2 CKM. Compared to individuals with low-income, high-income individuals diagnosed with T2D and CKD (4.8% vs. 1.1%), or T2D and MetS (4.9% vs. 2.1%) are 4.5 and 2.3 times more likely to use GLP-1, respectively. Among individuals with T2D, MetS, and CKD, GLP-1 utilization was 2.8 times higher among those with higher education compared to those with lower education (5.2% vs. 1.9%). All results are unadjusted.

Conclusions: SDOH-driven disparities limit GLP-1 therapy access. Patients with low income, no insurance or lack of routine care had the lowest uptake. These findings underscore the urgent need to address socioeconomic and structural barriers to GLP-1 access. Expanding access may play a critical role in slowing CKM progression, reducing cardiovascular risks, and mitigating long-term health disparities.