Ethnic differences in the comparative effectiveness of second‐line type 2 diabetes medications in preventing cardiovascular disease

TL;DR

This study found that DPP4i medications may be more effective than sulfonylureas in preventing cardiovascular issues in Black patients with type 2 diabetes.

Contribution

The study reveals potential ethnic differences in the effectiveness of DPP4i versus sulfonylureas for cardiovascular outcomes in type 2 diabetes.

Findings

DPP4i showed stronger effects against MACE in Black individuals compared to White or South Asian groups.

DPP4i was more effective in reducing heart failure hospitalisation in Black patients than in other ethnic groups.

No significant ethnic differences were found for other treatment comparisons or outcomes.

Abstract

To investigate ethnic differences in the comparative effectiveness of sulfonylureas (SU), dipeptidyl peptidase‐4 inhibitors (DPP4i) and sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) on cardiovascular outcomes.

We identified adults with type 2 diabetes in UK electronic health records initiating SU, DPP4i or SGLT2i (2015–2022). The outcomes were major adverse cardiovascular events (MACE: myocardial infarction, stroke, heart failure hospitalisation, cardiovascular death). Cox models estimated hazard ratios for DPP4i versus SU, SGLT2i versus SU and SGLT2i versus DPP4i. Wald tests assessed interaction by ethnicity.

Among 91 116 included individuals (72.3% White, 14.2% South Asian, 6.0% Black), 34.2% initiated an SU, 42.0% DPP4i and 23.8% SGLT2i. There was weak evidence of interaction by ethnicity for DPP4i versus SU on MACE (p = 0.12), with stronger effects observed for DPP4i in the Black group (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.46–0.89) than White (HR: 0.91, 95% CI: 0.84–0.98) or South Asian (HR: 0.93, 95% CI: 0.75–1.16) groups. There was evidence of interaction by ethnicity for DPP4i versus SU on heart failure hospitalisation (p = 0.05), with a stronger effect observed for DPP4i in the Black group (HR: 0.50, 95% CI: 0.30–0.84). There was no clear evidence of ethnic differences for other treatment comparators or cardiovascular outcomes.

We found weak evidence suggesting a greater effect of DPP4i than SUs against MACE in Black people, particularly for heart failure hospitalisation, but no evidence of other ethnic differences in treatment effects.

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