Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Sushrima Gan; Adem Y. Dawed; Louise A. Donnelly; A. T. N. Nair; Colin N. A. Palmer; Viswanathan Mohan; Ewan R. Pearson

doi:10.2337/dc19-2419

Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Sushrima Gan, Adem Y. Dawed, Louise A. Donnelly, A. T. N. Nair, Colin N. A. Palmer, Viswanathan Mohan, Ewan R. Pearson (Lead / Corresponding author)

Population Health and Genomics

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47 Citations (Scopus)

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Abstract

Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs).

Data Sources:A literature search was conducted in PubMed of all randomized, placebocontrolled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords.

Study selection: 64 studies qualified for meta-analysis after full-text review based on predefined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis.

Data extraction: Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study.

Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms.

Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians.

Conclusion: The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.

PROSPERO registration: [CRD42019133587]

Original language	English
Pages (from-to)	1948-1957
Number of pages	10
Journal	Diabetes Care
Volume	43
Issue number	8
Early online date	10 Jul 2020
DOIs	https://doi.org/10.2337/dc19-2419
Publication status	Published - Aug 2020

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Advanced and Specialised Nursing

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2337/dc19-2419

Author Accepted ManuscriptAccepted author manuscript, 903 KB

2 Finished

Scotland India Diabetes Health Informatics Unit (joint with Madras Diabetes Research Foundation)
Doney, A. (Investigator), McCrimmon, R. (Investigator), Palmer, C. (Investigator), Pearson, E. (Investigator) & Trucco, M. (Investigator)
1/06/17 → 30/09/21
Project: Research
Stratified Medicine in Type 2 Diabetes: Insights from the Study of Drug Response (New Investigator Award)
Pearson, E. (Investigator)
16/02/15 → 15/08/21
Project: Research

47 Citations
1 Article

Response to Comment on Gan et al. Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2020;43:1948–1957
Gan, S., Dawed, A. Y., Donnelly, L. A., Nair, A. T. N., Palmer, C. N. A., Mohan, V. & Pearson, E. R. (Lead / Corresponding author), Dec 2020, In: Diabetes Care. 43, 12, p. e202-e203 2 p.
Research output: Contribution to journal › Article › peer-review

Open Access

3 Citations (Scopus)

Dawed, Adem
- Diabetes Endocrinology and Reproductive Biology - Honorary Lecturer
Person: Honorary

Cite this

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title = "Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials",

abstract = "Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs).Data Sources:A literature search was conducted in PubMed of all randomized, placebocontrolled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords.Study selection: 64 studies qualified for meta-analysis after full-text review based on predefined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis.Data extraction: Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study.Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms.Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians.Conclusion: The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.PROSPERO registration: [CRD42019133587]",

author = "Sushrima Gan and Dawed, {Adem Y.} and Donnelly, {Louise A.} and Nair, {A. T. N.} and Palmer, {Colin N. A.} and Viswanathan Mohan and Pearson, {Ewan R.}",

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T1 - Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes

T2 - A Systematic Review and Meta-analysis of Randomized Controlled Trials

AU - Gan, Sushrima

AU - Dawed, Adem Y.

AU - Donnelly, Louise A.

AU - Nair, A. T. N.

AU - Palmer, Colin N. A.

AU - Mohan, Viswanathan

AU - Pearson, Ewan R.

N1 - Funding: Wellcome Trust 102820/Z/13/Z

PY - 2020/8

Y1 - 2020/8

N2 - Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs).Data Sources:A literature search was conducted in PubMed of all randomized, placebocontrolled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords.Study selection: 64 studies qualified for meta-analysis after full-text review based on predefined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis.Data extraction: Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study.Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms.Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians.Conclusion: The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.PROSPERO registration: [CRD42019133587]

AB - Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs).Data Sources:A literature search was conducted in PubMed of all randomized, placebocontrolled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords.Study selection: 64 studies qualified for meta-analysis after full-text review based on predefined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis.Data extraction: Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study.Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms.Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians.Conclusion: The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.PROSPERO registration: [CRD42019133587]

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DO - 10.2337/dc19-2419

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SP - 1948

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JO - Diabetes Care

JF - Diabetes Care

IS - 8

ER -

Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

ASJC Scopus subject areas

UN SDGs

Access to Document

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Projects

Scotland India Diabetes Health Informatics Unit (joint with Madras Diabetes Research Foundation)

Stratified Medicine in Type 2 Diabetes: Insights from the Study of Drug Response (New Investigator Award)

Research output

Response to Comment on Gan et al. Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2020;43:1948–1957

Profiles

Dawed, Adem

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