A Danish study reveals that unemployed and retired adults with type 2 diabetes and cardiovascular disease are less likely to receive recommended glucose-lowering treatments, highlighting ongoing disparities in healthcare access.
A large Danish registry study has found that adults with newly diagnosed type 2 diabetes and cardiovascular disease were less likely to begin heart-protective glucose-lowering medicines if they were unemployed or retired, adding to concerns that social and occupational factors continue to shape access to evidence-based care. The research, published online in Diabetes, Obesity and Metabolism and led by Elena Calderon of Steno Diabetes Centre Aarhus at Aarhus University Hospital, analysed national data from 2015 to 2022 and included 81,361 people with both conditions.
The medicines in question were sodium-glucose co-transporter-2 inhibitors, known as SGLT2 inhibitors, and glucagon-like peptide-1 receptor agonists, or GLP-1 drugs. These treatments are widely recommended because they can help lower cardiovascular risk in people with type 2 diabetes and established heart disease. In the Danish cohort, 24,623 patients started one of these therapies during follow-up, with most beginning an SGLT2 inhibitor. But after adjustment for other factors, unemployment and retirement remained linked to lower treatment initiation in both women and men.
The pattern was not limited to work status. Marital status also appeared to matter, with lower initiation among divorced, widowed and unmarried patients compared with married people. By contrast, educational level did not remain associated with treatment once other variables were taken into account. The authors said the findings point to barriers that may include cost, reimbursement rules, prescribing habits and differences in the way patients interact with the health system.
The new report fits with earlier Danish research showing that women were slower than men to start cardioprotective glucose-lowering drugs, particularly among patients with ischaemic heart disease and heart failure. Other nationwide analyses have also suggested that these medicines have been underused in routine practice and that lower socioeconomic position is associated with poorer uptake. The latest study, however, has an important caveat: follow-up began before the 2019 guideline update that broadened recommendations for these drugs regardless of glycated haemoglobin, or A1c, meaning some early variation may reflect the evolving evidence base rather than current practice alone.
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