Efficacy of Modern Diabetes Treatments- Dpp-4i, Sglt-2i, Glp-1ra- in White and Asian Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
<b><i><u>Background and Purpose:</u></i></b>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). <p><b><i><u>Data Sources:</u></i></b>A literature search was conducted in PubMed of all randomized, placebo-controlled 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.</p> <p><b><i><u>Study selection :</u></i></b> 64 studies qualified for meta-analysis after full-text review based on pre-defined 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.</p> <p><b><i><u>Data extraction:</u></i></b>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.</p> <p><b><i><u>Data synthesis: </u></i></b>Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms. </p> <p><b><i><u>Limitations: </u></i></b> Study is based on summarized data and could not be separated based on East Asians and South Asians.</p> <p><b><i><u>Conclusion : </u></i></b>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.</p>