Among 4,520 NHANES participants (representing ~84 million U.S. adults with Type 2 diabetes and Stage 2 Cardiovascular-Kidney-Metabolic syndrome, 2005–2020), profound socioeconomic gaps in GLP-1 receptor agonist access emerged. Uninsured patients were 81% less likely to use GLP-1 RAs; those with lower income and less than high school education faced 64% and 51% lower odds, respectively. No GLP-1 RA use was recorded among individuals lacking a routine care site. LASSO regression confirmed income, education, insurance, and care access as the dominant predictors.
GLP-1 receptor agonists — including semaglutide and tirzepatide — have reshaped cardiometabolic medicine, demonstrating renal protection, cardiovascular event reduction, and weight loss in landmark trials like CREDENCE, FLOW, and SELECT. Yet this cross-sectional analysis reveals that the patients facing the highest cardiorenal burden — lower-income, uninsured, less-educated — are precisely those least likely to receive these drugs. This mirrors well-documented access gaps with earlier therapeutic innovations like statins and ACE inhibitors, suggesting structural barriers persist across pharmacological generations.
Critical limitations apply: the cross-sectional design cannot establish causation, and NHANES data end in 2020, predating semaglutide's explosive market expansion and Medicare negotiations that may have shifted access dynamics. Physician prescribing patterns, patient hesitancy, and supply constraints are not captured. As a preprint posted on medRxiv and not yet peer-reviewed, these findings require independent validation before informing policy. Still, the magnitude of disparity documented here — up to 81% reduced odds — is clinically alarming and reinforces urgent calls for insurance coverage mandates and patient assistance program expansion.