How new diabetes drugs impacts black populations

As all practice managers are aware, the effective treatment of long-term conditions plays a significant role in positive outcomes for both the practice and it’s patients, and diabetes is a major player in the long term conditions category. Here we delve into the complex world of diabetes drug efficacy across ethnicities and uncover vital insights that could help healthcare providers and managers.

CREDIT: This is an edited version of an article that originally appeared on Medscape

In the realm of diabetes management, recent revelations from the Diabetes Research Centre at the University of Leicester have ignited fresh discussions. Their study, delving into the fascinating world of diabetes drugs and their effects on different racial and ethnic groups, has unveiled intriguing insights for practice managers.

The Paradigm Shift: New Diabetes Drugs

Traditionally, diabetes management revolved around stalwarts like metformin, whose benefits primarily stemmed from controlling blood sugar levels. However, a new generation of diabetes drugs has entered the arena, offering a broader spectrum of advantages. These modern agents not only excel in blood glucose control but also bring forth a host of other benefits, including blood pressure regulation, weight management, improved renal function, and significant reductions in cardiovascular and renal risks.

The Riddle of Racial Disparities

Despite the promise of these new drugs, a lingering question remained: Do these benefits extend uniformly across diverse racial and ethnic backgrounds? To answer this, researchers embarked on a systematic meta-analysis involving 14 placebo-controlled trials of SGLT2 inhibitors and GLP1 receptor agonists, with seven trials for each drug, all meticulously reporting cardiovascular and renal outcomes based on race and ethnicity.

For White and Asian populations, the new drugs exhibited a spectrum of advantages, spanning blood pressure control, weight management, renal function enhancement, and significant reductions in major adverse cardiovascular events and kidney diseases. However, a stark divide emerged when it came to Black populations – the benefits appeared conspicuously absent.

The data failed to demonstrate significant improvements in major adverse cardiovascular events, a composite measure of CVD death and heart failure hospitalization, or composite renal outcomes for Black patients, with the exception of a reduction in heart failure hospitalizations linked to SGLT2 inhibitors.

The Challenge of Representation

A critical aspect that cannot be ignored is the representation of racial and ethnic groups in these pivotal trials. While the proportion of different ethnicities in these trials varied significantly, they did not specifically account for racial and ethnic variations when evaluating cardiovascular outcomes.

The research team acknowledged that numerous factors could contribute to the absence of evidence regarding the benefits of SGLT2 inhibitors and GLP1 receptor agonists in Black and other non-White populations. The limited sample sizes of these populations might result in low statistical power, making it challenging to draw concrete conclusions.

However, the researchers also highlighted a consistent pattern of a lack of beneficial effects across various outcomes for Black populations, suggesting that other factors might be in play. Potential racial and ethnic variations in the way these drugs interact with the body, similar to variations seen in antihypertensive medications, demanded further investigation.

A Multifaceted Challenge

Moreover, Black populations are known to face a higher prevalence of major cardiovascular risk factors such as hypertension, dyslipidaemia, smoking, physical inactivity, and additional co-morbidities compared to their White counterparts. These factors contribute to an elevated baseline risk for adverse cardiovascular and renal events, and they often require lifestyle modifications that cannot be fully addressed by trial drugs.

The Call to Action

The research findings raise concerns, given the well-documented evidence that Black and other ethnic minority populations are more susceptible to developing type 2 diabetes at a younger age. Addressing racial and ethnic disparities in the cardiovascular and renal complications of type 2 diabetes requires targeted efforts to enhance access to care and treatment for those at heightened risk.

While the question of whether differences arise from under-representation or unique interactions between the body and these drugs calls for further exploration, it’s imperative not to rush to conclusions. Prescribers should exercise caution and avoid denying these new drugs to Black populations based solely on this research.