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

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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 languageEnglish
Pages (from-to)1948-1957
Number of pages10
JournalDiabetes Care
Volume43
Issue number8
Early online date10 Jul 2020
DOIs
Publication statusPublished - Aug 2020

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