{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:02:05Z","timestamp":1791406925415,"version":"4.3.3"},"reference-count":19,"publisher":"American Diabetes Association","issue":"2","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Identifying social and economic factors associated with initiation of semaglutide or tirzepatide may inform strategies to support equitable uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted using 100% of Medicare claims of patients \u226565 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 and ethnicity, dual enrollment in Medicare and Medicaid, rurality, and social vulnerability index), accounting for demographic and clinical characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 13,922,387 patients with T2DM, 673,776 (4.8%) initiated semaglutide or tirzepatide in 2023. Minoritized racial and ethnic identity (e.g., non-Hispanic Black compared with White; aOR 0.72; 95% CI 0.71\u20130.72), dual enrollment (aOR 0.90; 0.89\u20130.91), and residence in the most versus least vulnerable socially vulnerable neighborhoods (aOR 0.93; 0.92\u20130.93) were associated with lower initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Minoritized racial and ethnic identity and adverse socioeconomic factors were associated with lower odds of initiation among Medicare beneficiaries with T2DM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-1619","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T16:09:31Z","timestamp":1764950971000},"page":"277-281","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":3,"title":["Socioeconomic Factors and Initiation of Semaglutide or Tirzepatide Among Medicare Beneficiaries With Type 2 Diabetes"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-3079","authenticated-orcid":false,"given":"S\u00e9rgio R.R.","family":"Decker","sequence":"first","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center 1 , Boston, MA"},{"name":"Harvard Medical School 2 , Boston, MA"},{"name":"Department of Internal Medicine and MOVE Outcomes Research Lab, Moinhos de Vento Hospital 3 , Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard S.","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center 1 , Boston, MA"},{"name":"Harvard Medical School 2 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center 1 , Boston, MA"},{"name":"Department of Health Promotion and Behavioral Sciences, Kyoto University Graduate School of Medicine 4 , Kyoto, Japan"},{"name":"Hakubi Center, Kyoto University 5 , Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Song","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center 1 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1603-282X","authenticated-orcid":false,"given":"Chiadi E.","family":"Ndumele","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine 6 , Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-1859","authenticated-orcid":false,"given":"Sadiya S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine 7 , Chicago, IL"},{"name":"Department of Preventive Medicine, Northwestern University Feinberg School of Medicine 8 , Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9510-2979","authenticated-orcid":false,"given":"Dhruv S.","family":"Kazi","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center 1 , Boston, MA"},{"name":"Harvard Medical School 2 , Boston, MA"},{"name":"Harvard T.H. Chan School of Public Health 9 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"2026061811383736700_B1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1056\/NEJMoa2403347","article-title":"Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes","volume":"391","author":"Perkovic","year":"2024","journal-title":"N Engl J Med"},{"key":"2026061811383736700_B2","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1056\/NEJMoa1607141","article-title":"Semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"2026061811383736700_B3","doi-asserted-by":"crossref","first-page":"S181","DOI":"10.2337\/dc25-S009","article-title":"9. Pharmacologic approaches to glycemic treatment\u2014Standards of Care in Diabetes\u20132025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"2026061811383736700_B4","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1001\/jamacardio.2024.4657","article-title":"Semaglutide eligibility across all current indications for US adults","volume":"10","author":"Shi","year":"2025","journal-title":"JAMA Cardiol"},{"key":"2026061811383736700_B5","doi-asserted-by":"crossref","first-page":"e214182","DOI":"10.1001\/jamahealthforum.2021.4182","article-title":"Racial, ethnic, and socioeconomic inequities in glucagon-like peptide-1 receptor agonist use among patients with diabetes in the US","volume":"2","author":"Eberly","year":"2021","journal-title":"JAMA Health Forum"},{"key":"2026061811383736700_B6","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1001\/jama.2022.13885","article-title":"Association of race and ethnicity with prescription of SGLT2 inhibitors and GLP1 receptor agonists among patients with type 2 diabetes in the Veterans Health Administration System","volume":"328","author":"Lamprea-Montealegre","year":"2022","journal-title":"JAMA"},{"key":"2026061811383736700_B7","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2337\/dc22-0383","article-title":"Deficits and disparities in early uptake of glucagon-like peptide 1 receptor agonists and SGLT2i among Medicare-insured adults following a new diagnosis of cardiovascular disease or heart failure","volume":"46","author":"Cromer","year":"2023","journal-title":"Diabetes Care"},{"key":"2026061811383736700_B8","doi-asserted-by":"crossref","first-page":"100564","DOI":"10.1016\/j.xkme.2022.100564","article-title":"Disparities in SGLT2 inhibitor or glucagon-like peptide 1 receptor agonist initiation among Medicare-insured adults with CKD in the United States","volume":"5","author":"Zhao","year":"2023","journal-title":"Kidney Med"},{"key":"2026061811383736700_B9","doi-asserted-by":"crossref","first-page":"258","DOI":"10.2337\/dci20-0053","article-title":"Social determinants of health and diabetes: a scientific review","volume":"44","author":"Hill-Briggs","year":"2020","journal-title":"Diabetes Care"},{"key":"2026061811383736700_B10","doi-asserted-by":"crossref","first-page":"e2455222","DOI":"10.1001\/jamanetworkopen.2024.55222","article-title":"Factors associated with semaglutide initiation among adults with obesity","volume":"8","author":"Podolsky","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026061811383736700_B11","unstructured":"Cubanski\n              J\n            , DamicoA. Key Facts About Medicare Part D Enrollment and Costs in 2023. Kaiser Family Foundation, 2023. Accessed 3 October 2025. Available from https:\/\/www.kff.org\/medicare\/key-facts-about-medicare-part-d-enrollment-and-costs-in-2023\/"},{"key":"2026061811383736700_B12","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"key":"2026061811383736700_B13","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/ajhp\/zxae105","article-title":"National trends in prescription drug expenditures and projections for 2024","volume":"81","author":"Tichy","year":"2024","journal-title":"Am J Health Syst Pharm"},{"key":"2026061811383736700_B14","unstructured":"Duchovney\n            \n          . N. The Federal Perspective on Coverage of Medications to Treat Obesity: Considerations From the Congressional Budget Office. Congressional Budget Office. Presentation at the National Academies\u2019 Roundtable on Obesity Solutions. March 20, 2024. Accessed 3 October 2025. Available from https:\/\/www.cbo.gov\/publication\/60116"},{"key":"2026061811383736700_B15","unstructured":"Swagel\n              P\n            \n          . A Call for New Research in the Area of Obesity, 2023. Congressional Budget Office. Accessed 13 March 2025. 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