Diabetes CareType 2 DiabetesDecember 5, 2025

Socioeconomic Factors and Initiation of Semaglutide or Tirzepatide Among Medicare Beneficiaries With Type 2 Diabetes.

Decker SRR, Chaudhary RS, Inoue K, Song Y, Ndumele CE, Khan SS, Kazi DS

View on PubMed DOI: pii: dc251619. 10.2337/dc25-1619

Key Finding

Among nearly 14 million Medicare patients with type 2 diabetes, Black patients were 28% less likely and patients in the most socially vulnerable neighborhoods were 7% less likely to start the breakthrough diabetes drugs semaglutide or tirzepatide compared to their more advantaged counterparts.

What This Study Found

This massive study examined the medical records of almost 14 million Medicare patients aged 65 and older with type 2 diabetes to see who actually got prescribed semaglutide (Ozempic) or tirzepatide (Mounjaro) in 2023. Think of it like studying who gets invited to an exclusive party - the researchers wanted to know if everyone had equal access to these game-changing medications. Out of this enormous group, only about 674,000 patients (4.8%) actually started one of these drugs - imagine if only 1 out of every 20 people who could benefit from a life-saving treatment actually received it. The results revealed troubling disparities that look like invisible barriers at the pharmacy door. Black patients faced the steepest hurdles, being 28% less likely to start these medications compared to white patients. It's as if there's an extra flight of stairs that some patients have to climb to reach the same treatment. Patients who qualified for both Medicare and Medicaid (indicating lower income) were 10% less likely to get these drugs, and those living in the most socially vulnerable neighborhoods - areas with higher poverty, less education, and fewer resources - were 7% less likely to access treatment.

Statistics Decoded

The adjusted odds ratio of 0.72 for Black vs. white patients means Black patients had 28% lower odds of getting these drugs - this wasn't just bad luck, the statistical confidence was rock-solid (99.9% certain the real difference is between 28-29% lower odds). The 0.90 odds ratio for dual Medicare-Medicaid enrollment means these lower-income patients were 10% less likely to start treatment. The 0.93 odds ratio for high social vulnerability areas translates to 7% lower odds - while seemingly small, across millions of patients this represents tens of thousands of people potentially missing out on treatment. The fact that only 4.8% of eligible patients started these drugs suggests these medications are still reaching a tiny fraction of people who could benefit.

Why This Matters

These findings expose a troubling reality: the most innovative diabetes treatments are creating a two-tiered healthcare system where your zip code, income, and race predict whether you'll get breakthrough care. For the healthcare system, this demands urgent action to remove barriers and ensure equitable access to medications that can transform diabetes management and prevent serious complications.

Original 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.