Background

Type 2 Diabetes Mellitus (T2DM) management is a major focus for the Medicare beneficiary population (ages 65-85), a group characterized by a high burden of comorbidities and significant risk for costly events. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are high-cost, high-benefit medications.

A key variable in assessing this risk is the Charlson Comorbidity Index (CCI). The CCI is the most widely used comorbidity index used to determine survival rate (1yr and 10yr) in patients with multiple comorbidities.

Hospitalizations are a critical outcome in T2DM care, as these events signal serious acute complications, disease progression, or ineffective management. For Medicare, reducing hospitalization rates is a high-priority goal because it correlates directly with improved patient health and substantial cost savings.

The aim of this analysis is to determine the difference in disease burden (CCI score) between GLP-1 RA users and non-users, and to evaluate the association between GLP-1 use and hospitalization status among Medicare patients.

Data Source

glp1_data.csv

Results

Figure 1

Figure 1 (Charlson Comorbidity Score by GLP-1 Use) compares the disease burden (CCI score) between GLP-1 RA users and non-users. The t-test confirms a highly statistically significant difference in the mean Charlson Comorbidity Index Score between the groups (p < 0.0001). The descriptive statistics indicate that Non-GLP-1 users have a higher mean comorbidity burden ( ) compared to GLP-1 users (\(\text{CCI} \approx 3.37\)).

Figure 2

Figure 2 (Hospitalization Status by GLP-1 Use) evaluates the association between GLP-1 RA therapy and subsequent hospitalization status. The Chi-squared test confirms that there is no statistically significant association between GLP-1 use and the rate of hospitalization in this cohort (p = 0.130).

Conclusion 

This analysis reveals that Medicare beneficiaries with the highest comorbidity burden (CCI) are statistically less likely to receive GLP-1 RA therapy (p < 0.0001). Although the study found no statistically significant association between GLP-1 use and reduced hospitalization in this cohort (p = 0.130), the substantial prescribing disparity remains the primary finding. Therefore, efforts should focus on identifying and removing the systemic barriers that limit equitable access to GLP-1 RAs for the highest-risk patients.

References

1. American Diabetes Association. Medicare. Diabetes.org. https://diabetes.org/tools-resources/health-insurance-support/medicare. Accessed December 2, 2025. 2.Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8-35. doi:10.1159/000521288