A new study analyzing the effects of two drugs used to treat type 2 diabetes has consistently shown no cardiovascular or renal benefits in the black population. Cardiovascular disease is the leading cause of serious morbidity and mortality associated with type 2 diabetes. Kidney disease is also a common complication of type 2 diabetes.
These drugs, called sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) and glucogen-like peptide 1 receptor agonists (GLP1-RAs), are some of the newer treatments being prescribed to lower blood sugar levels in people with type 2 diabetes.
According to a study published in the Journal of the Royal Society of Medicine, in white and Asian people, SGLT2-Is and GLP1-RAs have beneficial effects on blood pressure, weight control and kidney function, significantly reducing the risk of severe heart and kidney disease, but the study did not show evidence of these beneficial effects in the black population.
Researchers from the Diabetes Research Centre at the University of Leicester analysed the results of 14 randomised controlled trials of SGLT2-Is versus GLP1-RAs and reported cardiovascular and renal outcomes by race, ethnicity and region.
Lead researcher Professor Samuel Seydoux, Professor of Primary Care Diabetes and Cardiometabolic Medicine at the University of Leicester, said: “The lack of consistent benefit in black populations is concerning given the well-documented evidence that black and other minority ethnic groups are more likely to develop type 2 diabetes and at a younger age.”
“Minimizing racial and ethnic disparities in cardiovascular and renal complications of type 2 diabetes requires focused improvements in access to care and treatment for those most at risk.”
The researchers suggest that the lack of evidence of beneficial effects for blacks and other non-white populations may be due to a number of factors, including low statistical power resulting from small sample sizes in these populations.
It is clear from current data that some racial/ethnic groups, such as the Black population, are underrepresented in all included trials.”
Professor Samuel Seydoux, Professor of Primary Care Diabetes and Cardiometabolic Medicine, University of Leicester
Trial participation rates ranged from 66.6% to 93.2% in white populations, 1.2% to 21.6% in Asian populations, and 2.4% to 8.3% in black populations.
However, the researchers suggest that other factors may also be at play, given the consistent nature of the striking lack of beneficial effects across the majority of outcomes for the black population.
“Whether this difference is due to issues of underrepresentation of the black population and low statistical power, or whether it is due to racial/ethnic differences in the interactions of these drugs with the human body, requires further investigation,” Professor Seydoux said. “It is therefore important that prescribers do not rush to deny these new treatments to the black population because of this study.”
sauce:
Royal Society of Medicine
Journal References:
Kunutsor, SK, et al. (2023). Racial, ethnic, and regional differences in the effects of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists on cardiovascular and renal outcomes: a systematic review and meta-analysis of cardiovascular outcomes trials. Journal of the Royal Society of Medicine. doi.org/10.1177/01410768231198442.
