Socioeconomic Factors and Initiation of Semaglutide or Tirzepatide Among Medicare Beneficiaries With Type 2 Diabetes.
Decker. Sérgio R R SRR; Chaudhary. Richard S RS; Inoue. Kosuke K; Song. Yang Y; Ndumele. Chiadi E CE; Khan. Sadiya S SS; Kazi. Dhruv S DS
Key Findings
- 4.8% of Medicare beneficiaries with type 2 diabetes initiated semaglutide or tirzepatide in 2023.
- Non‑Hispanic Black patients had 28% lower odds of starting the drugs compared with White patients (aOR 0.72).
- Dual enrollment in Medicare and Medicaid reduced initiation odds (aOR 0.90).
- Living in the most socially vulnerable neighborhoods lowered odds of initiation (aOR 0.93).
Practical Outcomes
- The study highlights that cost, insurance coverage, and social factors can limit access to these promising anti‑diabetes/weight‑loss peptides. For self‑directed users, it underscores the importance of checking insurance benefits, seeking financial assistance programs, and advocating for equitable access if you belong to a disadvantaged group.
Summary
In 2023, only about 5% of older Medicare patients with type 2 diabetes started using the weight‑loss drugs semaglutide or tirzepatide. People who are Black, have both Medicare and Medicaid, or live in poorer neighborhoods were less likely to begin these treatments.
Abstract
Identifying social and economic factors associated with initiation of semaglutide or tirzepatide may inform strategies to support equitable uptake. A cross-sectional study was conducted using 100% of Medicare claims of patients ≥65 years with type 2 diabetes mellitus (T2DM). The outcome was initiation of semaglutide or tirzepatide. We calculated adjusted odds ratios (aORs) for each exposure (self-reported race/ethnicity, dual enrollment in Medicare and Medicaid, rurality, and social vulnerability index), accounting for demographic and clinical characteristics. Among 13,922,387 patients with T2DM, 673,776 (4.8%) initiated semaglutide or tirzepatide in 2023. Minoritized racial/ethnic identity (e.g., non-Hispanic Black compared with White; aOR 0.72; 95% CI 0.71-0.72), dual enrollment (aOR 0.90; 0.89-0.91), and residence in the most versus least vulnerable socially vulnerable neighborhoods (aOR 0.93; 0.92-0.93) were associated with lower initiation. Minoritized racial/ethnic identity and adverse socioeconomic factors were associated with lower odds of initiation among Medicare beneficiaries with T2DM.
Study Information
pubmed
2025
2025-12-05T00:00:00.000Z
10.2337/dc25-1619