Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
Division of Cardiac Surgery, University of Toronto, St. Michael' Hospital, Toronto, Canada.
Diabetes Obes Metab. 2020 Dec;22(12):2384-2397. doi: 10.1111/dom.14164. Epub 2020 Sep 10.
To explore cardiometabolic risk profiles, the probability of sustainable control, and the effectiveness of treatment with sodium-glucose co-transporter-2 (SGLT2) inhibitors in black and white adults in the United States with type 2 diabetes.
Using nationally representative US electronic medical records, 72 690 white and 10 004 black adults diagnosed with type 2 diabetes initiating SGLT2 inhibitors during the period 2013 to 2018, continuing it for ≥6 months, and with follow-up of ≥12 months, were identified. Glycated haemoglobin (HbA1c), body weight, systolic blood pressure (SBP) and lipid changes at 6 months, and sustainability of control over 18 months post SGLT2 inhibitor initiation were explored, separately in those with and without atherosclerotic cardiovascular disease (ASCVD).
The white group was older (58 years) with lower mean HbA1c (8.5%), compared to the black group (age 54 years, HbA1c 9.0%). Body mass index distribution was similar. The proportions of people with uncontrolled SBP, LDL cholesterol, non-HDL cholesterol and triglyceride levels were 24%, 42%, 51% and 62%, respectively, in white patients, and 31%, 51%, 49% and 32%, respectively, in black patients. At 6-month follow-up white and black patients had similar adjusted reductions in HbA1c (1.1%), SBP (8-10 mmHg), LDL cholesterol (0.26 - 0.34 mmol / L) and body weight (1.1-1.4 kg). However, over 18 months' follow-up, compared to white patients, black patients were significantly less likely to achieve sustainable control in HbA1c (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.63-0.72), body weight (OR 0.81, 95% CI 0.72-0.91), SBP (OR 0.67, 95% CI 0.61-0.74) and LDL cholesterol (OR 0.77, 95% CI 0.67-0.89). Triglyceride control was significantly better among black patients. Black patients had a significantly higher risk factor burden, irrespective of ASCVD status.
While the effectiveness of SGLT2 inhibitors was similar among black and white patients, irrespective of ASCVD status, black patients continued to have worse cardiometabolic risk factor burden after SGLT2 inhibitor initiation.
探讨美国黑人和白人 2 型糖尿病患者的心脏代谢风险特征、持续控制的可能性以及钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂的治疗效果。
利用美国全国代表性的电子病历，确定了 2013 年至 2018 年期间开始接受 SGLT2 抑制剂治疗且治疗时间≥6 个月、随访时间≥12 个月的 72690 名白人患者和 10004 名黑人患者。分别探讨了在有和无动脉粥样硬化性心血管疾病（ASCVD）的患者中，SGLT2 抑制剂治疗后 6 个月时糖化血红蛋白（HbA1c）、体重、收缩压（SBP）和血脂的变化，以及治疗后 18 个月时的控制可持续性。
与黑人患者（年龄 54 岁，HbA1c 9.0%）相比，白人患者年龄更大（58 岁），平均 HbA1c 水平更低（8.5%）。两组的体重指数分布相似。白人患者中，血压、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和甘油三酯水平控制不良的比例分别为 24%、42%、51%和 62%，黑人患者的比例分别为 31%、51%、49%和 32%。在 6 个月的随访中，白人患者和黑人患者的 HbA1c（分别降低 1.1%和 1.0%）、SBP（分别降低 8-10mmHg）、低密度脂蛋白胆固醇（分别降低 0.26-0.34mmol/L）和体重（分别降低 1.1-1.4kg）的调整后降幅相似。然而，在 18 个月的随访中，与白人患者相比，黑人患者在 HbA1c（比值比[OR]0.67，95%置信区间[CI]0.63-0.72）、体重（OR 0.81，95%CI 0.72-0.91）、SBP（OR 0.67，95%CI 0.61-0.74）和低密度脂蛋白胆固醇（OR 0.77，95%CI 0.67-0.89）方面达到持续控制的可能性显著较低。黑人患者的甘油三酯控制明显更好。无论是否存在 ASCVD，黑人患者的危险因素负担均明显更高。
尽管 SGLT2 抑制剂在有和无 ASCVD 的黑人和白人患者中的疗效相似，但黑人患者在开始使用 SGLT2 抑制剂后，心脏代谢风险因素负担仍持续较差。
