A nationwide Danish cohort study of over 81,000 adults with newly diagnosed type 2 diabetes (T2D) and cardiovascular disease (CVD) found that employment status is a major predictor of whether patients receive guideline-recommended cardioprotective medications. Unemployed and retired patients — both men and women — were significantly less likely to start SGLT2 inhibitors or GLP-1 receptor agonists compared to their employed counterparts. Marital status also mattered, with unmarried, divorced, or widowed patients showing lower initiation rates.

Of the full cohort, only about 30% (24,623 patients) started a cardioprotective drug during follow-up, with SGLT2 inhibitors being the more commonly chosen option. Older age, newly diagnosed diabetes, and lower A1c levels were also linked to a higher likelihood of not starting these therapies — suggesting that patients perceived as lower-risk may be systematically undertreated.

By the Numbers:

• 81,361 adults with T2D + CVD studied; 37% were women
• Only ~30% initiated a cardioprotective glucose-lowering drug
• Unemployed men were 23% less likely to initiate vs. employed men (IRR 0.77)
• Unemployed women were 19% less likely vs. employed women (IRR 0.81)

Why it matters: These findings expose a troubling equity gap in cardiovascular diabetes care. Socioeconomic factors — not just clinical ones — are shaping who gets life-saving medications, underscoring the urgent need for systemic reforms in prescribing practices, cost coverage, and healthcare delivery.