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Whether access is worse in rural communities is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine fills of GLP1RA\/SGLT2i by adults with type 2 diabetes in rural and urban US counties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional use claims from OptumLabs\u00ae Data Warehouse, 2012\u20132021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Adults with type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Measures<\/jats:title>\n                    <jats:p>We examined rates and odds of fills of GLP1RA or SGLT2i, adjusting for time period, age, sex, presence of cardiorenal comorbidities (heart failure [HF], atherosclerotic cardiovascular disease [ASCVD], chronic kidney disease stages 3\u20134 [CKD]), and rurality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>The study included 2,579,577 adults with type 2 diabetes (mean age 63.9; 49.6% female). Compared to 2012\u20132015, fills of GLP1RA\/SGLT2i increased in 2016\u20132018 (OR 2.49; 95% CI 2.47\u20132.52) and 2019\u20132021 (OR 4.35; 95% CI 4.30\u20134.39). By 2019\u20132021, the percentages of patients filling GLP1RA\/SGLT2i in cities, small towns, and remote areas were 18.8%, 18.8%, and 17.4%, respectively. Small town residents had higher odds of fills than those in cities (OR 1.05; 95% CI 1.04\u20131.06). Older age was associated with lower fill rates; compared to 18\u201344\u00a0year olds, odds for those 45\u201364\u00a0years were OR 0.88 (95% CI 0.87\u20130.89), 65\u201374\u00a0years: OR 0.48 (95% CI 0.47\u20130.48), and\u2009\u2265\u200975\u00a0years: OR 0.17 (95% CI 0.17\u20130.18). Men were less likely to fill GLP1RA\/SGLT2i than women (OR 0.91; 95% CI 0.90\u20130.92). Presence of ASCVD and CKD were associated with greater odds of filling GLP1RA\/SGLT2i (OR 1.03 [95% CI 1.01\u20131.05] and OR 1.12 [95% CI 1.10\u20131.14], respectively), while HF was associated with lower odds (OR 0.86 [95% CI 0.85\u20130.88]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GLP1RA and SGLT2i fills increased over time but remained low overall. They were filled more often by younger people, women, those with ASCVD or CKD (but not with HF), and in small towns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-025-09784-0","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T18:52:21Z","timestamp":1754333541000},"page":"126-133","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fill Patterns of Glucose-Lowering Drugs with Cardiovascular and Kidney Benefits in the Rural and Urban United States, 2012\u20132021"],"prefix":"10.1007","volume":"41","author":[{"given":"Kyle","family":"Steiger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavya Sindhu","family":"Swarna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeph","family":"Herrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2289-3183","authenticated-orcid":false,"given":"Rozalina G.","family":"McCoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"issue":"Supplement_1","key":"9784_CR1","doi-asserted-by":"publisher","first-page":"S140","DOI":"10.2337\/dc23-S009","volume":"46","author":"NA ElSayed","year":"2022","unstructured":"ElSayed NA, Aleppo G, Aroda VR, et al. 9. 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Informed consent does not apply.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human Ethics and Consent to Participate"}},{"value":"No competing financial interests exist. In the last 36\u00a0months, Dr. McCoy has received support from NIDDK, National Institute on Aging of the NIH, the Patient Centered Outcomes Research Institute (PCORI), National Center for Advancing Translational Sciences (NCATS), and the American Diabetes Association for unrelated work. She served as a consultant to EmmiEducate\u00ae\u00a0(Wolters Kluwer) and the Yale-New Haven Health System\u2019s Center For Outcomes Research and Evaluation and has received speaking honoraria and travel support from the American Diabetes Association. In the last 36\u00a0months, Dr. Herrin has received support from the National Institutes of Health, PCORI, the Agency for Healthcare Research and Quality, and the Centers for Medicare and Medicaid Services.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Study contents are the sole responsibility of the authors and do not necessarily represent the official views of NIH.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}