Smokers with type 2 diabetes are significantly less likely too be prescribed glucagon-like peptide-1 receptor agonists (GLP-1s) – a class of drugs increasingly used for weight loss and cardiovascular benefit – than their nonsmoking counterparts, according to a recent study.
Researchers analyzing data from over 150,000 patients with type 2 diabetes found current smokers were 32% less likely to receive a GLP-1 prescription compared with those who had never smoked. This disparity exists despite GLP-1s demonstrating substantial clinical benefits for individuals with both diabetes and cardiovascular disease, conditions ofen exacerbated by smoking. The findings, published in Endocrine Today, raise concerns about potential inequities in access to these medications and highlight the need for clinicians to proactively address prescribing patterns to ensure equitable care for all patients with type 2 diabetes.
The retrospective cohort study, conducted by researchers at the University of Texas Health Science Center at San Antonio, examined electronic health record data from a large healthcare system between January 2018 and December 2023. The analysis included 153,888 patients diagnosed with type 2 diabetes. After adjusting for factors like age, sex, race, body mass index, HbA1c levels, and comorbidities, the association between smoking status and GLP-1 prescription remained statistically significant.
“We observed a consistent and substantial difference in GLP-1 prescription rates between smokers and nonsmokers, even after accounting for numerous confounding variables,” said Dr. Riddhi Sharma, lead author of the study. “This suggests that smoking status might potentially be an independent factor influencing prescribing decisions.”
The reasons for this disparity are not fully understood. Researchers hypothesize potential factors include clinician bias, assumptions about patient adherence, or a perceived lack of benefit in smokers due to their other health risks. However,they emphasize that these assumptions are not supported by evidence and could contribute to suboptimal care for a vulnerable population.
“It’s crucial for healthcare providers to recognize that smokers with type 2 diabetes can still derive significant benefits from GLP-1s,” Dr. Sharma stated.”These medications can improve glycemic control, promote weight loss, and reduce cardiovascular risk, all of which are particularly crucial for individuals who smoke.”
The study authors recommend further research to explore the underlying mechanisms driving this disparity and to develop strategies to mitigate potential inequities in GLP-1 access.They also advocate for educational initiatives to raise awareness among clinicians about the benefits of GLP-1s for smokers with type 2 diabetes and to address any biases that may be influencing prescribing decisions.
