Diabetes Medication Regimen Complexity and Glycemic Outcomes among Medically Underserved Latino Adults: Implications for Pharmacoequity

Abstract Latino adults in South Los Angeles living with type 2 diabetes mellitus (T2DM) experience disproportionate cardiometabolic complications alongside structural barriers that influence medication regimen complexity (MRC) and medication access. During 2017–2022, diabetes treatment guidelines increasingly emphasized cardioprotective antihyperglycemic medications while concurrent federal and state policy changes influenced health coverage continuity and pharmacy access for underserved populations. The present study evaluated the association between diabetes specific MRC (DM MRC) and cardiometabolic outcomes (glycemic, atherogenic cholesterol and blood pressure control) among underserved Latino adults living with T2DM and examined the implications of these relationships for pharmacoequity within the context of medication access and health system design. A single-center, cross-sectional retrospective chart review was conducted among 342 adults receiving primary care at a federally qualified health center in South Los Angeles between January 2017 and October 2022. Logistic regression analyses revealed a significant association between higher DM MRC and lower likelihood of glycemic control. Participants with moderate and high DM MRC were less likely to achieve glycemic control compared to those with low DM MRC. No associations were observed between diabetes specific MRC and atherogenic cholesterol and blood pressure control. There was a low uptake of cardioprotective medications such as sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists among the study population. Insurance status was also negatively and independently associated with glycemic control, highlighting the role of structural determinants and coverage related barriers in diabetes management. These findings suggest that DM MRC operates within a policy and pharmacoequity context in which insurance transitions, formulary restrictions, and administrative barriers may negatively impact access to evidence-based antihyperglycemic medications in structurally vulnerable populations. Pharmacist-integrated care models and policies that improve continuity of medication access and uptake of optimal diabetes medications may help reduce inequities in diabetes outcomes.