Why Are Minorities Less Likely to Be Prescribed GLP-1s?

It may seem that glucagon-like peptide-1 receptor agonists (GLP-1s) are everywhere these days. But these medications aren’t always easy to come by. And, it turns out, whether you’re prescribed one may partly depend on your racial background.

“It’s really concerning. We see disparities in a lot of evidence-based care for a variety of reasons,” says Ajaykumar Rao, MD, an associate professor of medicine and the chief of endocrinology, diabetes, and metabolism at Lewis Katz School of Medicine at Temple University in Philadelphia. “We all need to think about what factors are playing a role in doctors not prescribing GLP-1s for people from these backgrounds.”

“Perhaps lack of access to physicians who have read up on the up-to-date guidelines out there and kept themselves up to speed could be to blame. And there might be unmeasured factors like trust in doctors — or lack of it,” says Dr. Rao.

The study also points to structural racism and implicit bias as contributing factors to unequal prescribing patterns. This can stem from stereotypes about patient adherence, assumptions about their preferences, or even perceptions about the person’s lifestyle choices. The authors also noted that more research was needed to say how these factors continue to influence prescription practices.

Systemic inequality continues to affect treatment recommendations — even when those same medications can be just as effective for people of all races. In fact, there’s good reason to think Black and Latino people may be particularly good candidates for a GLP-1.

“The presence of cardiovascular disease — such as a history of a heart attack, stroke, or heart failure — are aspects we think about when considering GLP-1s, because there’s proven benefits for reducing all of these events in people with diabetes,” says Rao. Because of this, he adds, it’s crucial for your physician to take a good health history and uncover any information that could be linked to these conditions.

People who have a high BMI (body mass index) and a higher A1C level (a measurement of your average blood sugar levels over the past 3 months) also make good candidates for a GLP-1, especially because other type 2 diabetes medications aren’t always able to lower A1C levels as much as an injectable can, says Rao.

Plus, “There’s no doubt the medicines help with a little bit of weight loss,” he adds. “There are people who are in the overweight or obese phase of diabetes where these agents can be very helpful.”

If you think you might benefit from taking a GLP-1, don’t hesitate to initiate the conversation with your doctor. And don’t feel like you need to seek out a specialist to do so. “Primary care physicians are in a great position to get people going on these medicines,” says Rao.

Before bringing questions to your doctor, Rao recommends familiarizing yourself with the American Diabetes Association’s Standards of Care, a summary of the organization’s most current recommendations, which is updated annually. “Reading up on these can help people advocate for themselves in front of their providers,” he says. “Print those or have them on your phone and ask your doctor, ‘Are we following this?’” If the answer is no, ask why.

If your doctor determines that a GLP-1 may work for you, Rao advises asking the following questions, so you know what to expect when taking the meds:

• What are the side effects? “It’s always important to ask this, because you don’t want to read a list of possible side effects on the box when you get home, and get scared,” says Rao.
• What might my A1C levels look like? Your provider should be able to estimate what your blood sugar levels may be after 3 months and after 6 months.
• How do I administer it? Because most of these medications are injectables, make sure you’re comfortable with how to use them. If you’re not, ask your provider for help.

GLP-1s, while effective, are often expensive, even if insurance covers them. “Something could be covered, but then when you go to the pharmacy, you may still have an out-of-pocket cost,” says Rao.

For commercial insurance patients, there are manufacturer-supported cards or copay cards that can reduce costs, he says. If your provider’s connected with a hospital, there may also be an outpatient pharmacy offering a lower out-of-pocket cost.

Finally, Rao suggests looking into patient prescription assistance programs but notes that this can require a bit of work. (You or your provider may have to fill out some applications, for example.)

There’s also a generic GLP-1 called liraglutide on the market, which may be available at a lower price. While that medication could be a good fit for you, know that providers should always choose the most appropriate treatment for you and your health, Rao says.

• GLP-1 medications can significantly improve health outcomes for people with type 2 diabetes and obesity, but research suggests that many minorities are missing out.
• Black and Latino people particularly may benefit from taking a GLP-1: Black and Latino adults are more likely to be diagnosed with diabetes and to have high blood pressure — a risk factor for heart disease — than white people.
• Learning more about these medications, talking with your doctor, and finding ways to make them more affordable can help reduce the racial gap in GLP-1 prescriptions.