Medication Expenditures and Utilization Patterns among U.S. Adults with Diabetes across the Cardiovascular-Kidney-Metabolic (CKM) Continuum (2012–2021)
1
School of Public Health, Peking University, Beijing, China
2
Beijing-Dublin International College, Beijing University of Technology, Beijing, China
3
Institute for Global Health and Development, Peking University, Beijing, China
Popul. Med. 2026;8(Supplement Supplement 1):A3030
ABSTRACT
ABSTRACT:
Background Diabetes is a key component of the cardiovascular-kidney-metabolic (CKM) continuum; when cardiovascular and/or kidney disease co-occurs, premature mortality risk and pharmacological needs increase. Yet how prescription medication expenditures—particularly spending on glucose-lowering drugs—vary across CKM comorbidity profiles, and whether spending patterns align with guideline-recommended therapy, remain unclear. We assessed national trends in medication expenditures and glucose-lowering drugs (GLD) use among U.S. adults with diabetes, stratified by CKM components. Methods We analyzed 2012-2021 Medical Expenditure Panel Survey data. Adults with diabetes were stratified into four mutually exclusive groups based on CKM components: diabetes alone (D only), with cardiovascular disease (D+C), with chronic kidney disease (D+K), and with both conditions (D+K+C). We evaluated trends in per-capita expenditures for total prescription and GLD and the utilization of SGLT2i and GLP-1 RA, two GLD classes with established cardiorenal benefits. Results The sample included 130738 adults (mean age 49 years; 53.6% female): 68.6% D only, 22.7% D+C, 4.9% D+K, and 3.8% D+C+K. Total prescription and GLD expenditures increased substantially over time across groups. Per-capita total prescription spending and GLD spending increased with CKM burden (in 2020-2021: total prescription $5328 in D only, $8526 in D+C, $9866 in D+K, and $9970 in D+K+C; GLD: $3343 in D only, $3931 in D+C, $5614 in D+K, and $5940 in D+K+C). Insulin constituted 60.3% of total GLD costs, with significant higher expenditures in patients with cardiovascular or kidney disease. In contrast, SGLT2i/GLP-1 RA use was broadly similar across comorbidity profiles (in 2021: 21.1% D only, 20.6% in D+C, 28.4% in D+K, and 19.3% in D+C+K). Conclusions Cardiovascular and kidney comorbidities are associated with substantially higher prescription and glucose-lowering drug expenditures among US adults with diabetes, driven largely by insulin spending. Despite guideline-supported cardiorenal benefits, SGLT2i and GLP-1 RA uptake remains suboptimal and does not meaningfully increase among higher-risk groups.
Background Diabetes is a key component of the cardiovascular-kidney-metabolic (CKM) continuum; when cardiovascular and/or kidney disease co-occurs, premature mortality risk and pharmacological needs increase. Yet how prescription medication expenditures—particularly spending on glucose-lowering drugs—vary across CKM comorbidity profiles, and whether spending patterns align with guideline-recommended therapy, remain unclear. We assessed national trends in medication expenditures and glucose-lowering drugs (GLD) use among U.S. adults with diabetes, stratified by CKM components. Methods We analyzed 2012-2021 Medical Expenditure Panel Survey data. Adults with diabetes were stratified into four mutually exclusive groups based on CKM components: diabetes alone (D only), with cardiovascular disease (D+C), with chronic kidney disease (D+K), and with both conditions (D+K+C). We evaluated trends in per-capita expenditures for total prescription and GLD and the utilization of SGLT2i and GLP-1 RA, two GLD classes with established cardiorenal benefits. Results The sample included 130738 adults (mean age 49 years; 53.6% female): 68.6% D only, 22.7% D+C, 4.9% D+K, and 3.8% D+C+K. Total prescription and GLD expenditures increased substantially over time across groups. Per-capita total prescription spending and GLD spending increased with CKM burden (in 2020-2021: total prescription $5328 in D only, $8526 in D+C, $9866 in D+K, and $9970 in D+K+C; GLD: $3343 in D only, $3931 in D+C, $5614 in D+K, and $5940 in D+K+C). Insulin constituted 60.3% of total GLD costs, with significant higher expenditures in patients with cardiovascular or kidney disease. In contrast, SGLT2i/GLP-1 RA use was broadly similar across comorbidity profiles (in 2021: 21.1% D only, 20.6% in D+C, 28.4% in D+K, and 19.3% in D+C+K). Conclusions Cardiovascular and kidney comorbidities are associated with substantially higher prescription and glucose-lowering drug expenditures among US adults with diabetes, driven largely by insulin spending. Despite guideline-supported cardiorenal benefits, SGLT2i and GLP-1 RA uptake remains suboptimal and does not meaningfully increase among higher-risk groups.
| eISSN: | 2654-1459 |
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