Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand
Abstract Background Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovas...
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BMC
2025-03-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12601-3 |
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| author | Lynne Chepulis Mark Rodrigues Han Gan Rawiri Keenan Tim Kenealy Rinki Murphy Leanne Te Karu Jo Scott-Jones Penny Clark Allan Moffitt Sara Mustafa Ross Lawrenson Ryan Paul |
| author_facet | Lynne Chepulis Mark Rodrigues Han Gan Rawiri Keenan Tim Kenealy Rinki Murphy Leanne Te Karu Jo Scott-Jones Penny Clark Allan Moffitt Sara Mustafa Ross Lawrenson Ryan Paul |
| author_sort | Lynne Chepulis |
| collection | DOAJ |
| description | Abstract Background Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. Methods Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. Results Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access. Conclusion Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD. |
| format | Article |
| id | doaj-art-bebb9099bc0f40548289914b2e40d1d0 |
| institution | OA Journals |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-bebb9099bc0f40548289914b2e40d1d02025-08-20T02:10:10ZengBMCBMC Health Services Research1472-69632025-03-0125111210.1186/s12913-025-12601-3Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New ZealandLynne Chepulis0Mark Rodrigues1Han Gan2Rawiri Keenan3Tim Kenealy4Rinki Murphy5Leanne Te Karu6Jo Scott-Jones7Penny Clark8Allan Moffitt9Sara Mustafa10Ross Lawrenson11Ryan Paul12Waikato Medical Research Centre, University of WaikatoWaikato Medical Research Centre, University of WaikatoSchool of Computing and Mathematical Scienes, University of WaikatoWaikato Medical Research Centre, University of WaikatoFaculty of Medical and Health Sciences, University of AucklandFaculty of Medical and Health Sciences, University of AucklandFaculty of Medical and Health Sciences, University of AucklandMidlands Health NetworkNorthcare Medical CentreProcare Health LimitedWaikato Medical Research Centre, University of WaikatoWaikato Medical Research Centre, University of WaikatoWaikato Medical Research Centre, University of WaikatoAbstract Background Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. Methods Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. Results Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access. Conclusion Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.https://doi.org/10.1186/s12913-025-12601-3SGLT2iGLP1RAType 2 diabetesHealth system access |
| spellingShingle | Lynne Chepulis Mark Rodrigues Han Gan Rawiri Keenan Tim Kenealy Rinki Murphy Leanne Te Karu Jo Scott-Jones Penny Clark Allan Moffitt Sara Mustafa Ross Lawrenson Ryan Paul Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand BMC Health Services Research SGLT2i GLP1RA Type 2 diabetes Health system access |
| title | Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand |
| title_full | Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand |
| title_fullStr | Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand |
| title_full_unstemmed | Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand |
| title_short | Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand |
| title_sort | real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in new zealand |
| topic | SGLT2i GLP1RA Type 2 diabetes Health system access |
| url | https://doi.org/10.1186/s12913-025-12601-3 |
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