TOPLINE

In a nationwide Danish cohort of adults with newly diagnosed type 2 diabetes (T2D) and cardiovascular disease (CVD), those who were unemployed or retired were significantly less likely than those who were employed to start guideline-recommended cardioprotective glucose-lowering drugs. Marital status also influenced treatment initiation, and the effect of educational level disappeared after adjustment for other factors.

METHODOLOGY

• Researchers conducted a nationwide cohort study using Danish national health and administrative registries from 2015 through 2022 to estimate whether sex and socioeconomic status were associated with the initiation of cardioprotective glucose-lowering drugs among patients with both T2D and CVD.
• A total of 81,361 adults with newly diagnosed concomitant T2D and CVD were identified, of whom 37% were women.
• The initiation of cardioprotective glucose-lowering drugs was assessed by sex and three socioeconomic indicators: educational level (0-10, 10-15, or more than 15 years), marital status (married, divorced or widowed, or unmarried), and occupational status (employed, student, or other; retired; or unemployed).
• The primary endpoint was the initiation of a cardioprotective glucose-lowering drug, defined as the first filled prescription for an SGLT2 inhibitor or a GLP-1 receptor agonist after the dual diagnosis of T2D and CVD.
• Non-initiation was defined as no prescription for a cardioprotective glucose-lowering drug within 1 year of the dual diagnosis. The median follow-up duration for the full cohort was 2.7 years, with a maximum of 7.5 years.

TAKEAWAY

• Overall, 24,623 patients had started a cardioprotective glucose-lowering drug: 15,301 (62.1%) started an SGLT2 inhibitor and 9322 (37.9%) started a GLP-1 receptor agonist.
• After full adjustment, compared with employed women, incidence rate ratios were 0.81 (95% CI, 0.75-0.88) for unemployed women and 0.88 (95% CI, 0.79-0.97) for retired women; among men, the incidence rate ratios were 0.77 (95% CI, 0.73-0.81) for those who were unemployed and 0.83 (95% CI, 0.78-0.88) for those who were retired, compared with those who were employed.
• Compared with married women, the incidence rate ratios were 0.90 (95% CI, 0.85-0.96) for divorced or widowed women and 0.90 (95% CI, 0.82-0.99) for unmarried women. Among men, unmarried vs married men had lower initiation (incidence rate ratio, 0.86; 95% CI, 0.82-0.91). After full adjustment, the educational level was not associated with initiation in either sex.
• In the non-initiation analysis including 61,406 patients, older age, newly diagnosed diabetes, and lower A1c levels were linked to a higher risk for not starting cardioprotective drugs, as were unemployment and retirement; however, the educational level showed no clear association.

IN PRACTICE

"[The study] findings highlight the need for a multifactorial approach addressing barriers related to cost and reimbursement systems, healthcare delivery, prescribing practices and patient-level factors to ensure equitable access to evidence-based cardioprotective therapies," the authors wrote.

SOURCE

The study was led by Elena Calderon, Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. It was published online on September 20, 2026, in Diabetes, Obesity and Metabolism.

LIMITATIONS

Follow-up started in 2015, before the 2019 guideline update that recommended these drugs regardless of A1c levels, so early treatment patterns may have reflected the evolving evidence base rather than present-day underuse. Data on education levels and some lab values were missing for a proportion of patients. Unmeasured lifestyle factors could also have introduced bias into the results.

DISCLOSURES

The study was supported by an unrestricted grant from Boehringer Ingelheim. One author reported receiving speaker honoraria or consultancy fees from multiple sources and being an investigator in clinical studies sponsored by AstraZeneca or Viatris, in addition to receiving the unrestricted research grant from Boehringer Ingelheim noted above.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.