Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
Curr Diabetes Rev. 2021;17(9):e122820189511. doi: 10.2174/1573399817666201228120725.
South Asians experience more type 2 diabetes, which is earlier in onset and with more rapid glycaemic deterioration, although average body mass indices are lower than in whites. Cardiovascular outcomes from diabetes drug trials are now reported as standard, with data from newer therapies influencing patient management. However, less is known of the effect of such therapies in South Asians. The aim of this narrative review was to extract, wherever possible, the glucose-lowering efficacy and cardiovascular and renal outcome data for these therapies in South Asians.
Despite the higher prevalence and global burden of type 2 diabetes and adverse outcomes in South Asians, they remain underrepresented in global trials. Even when recruited, the current method of classifying ethnicity does not commonly allow South Asian data to be extracted and reported separately from all Asians. Interrogation of available trial data suggests broadly comparable effects on glycaemia and weight in Asians to other ethnicities with use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), but a potentially early, albeit marginally, greater glycaemia benefit with Dipeptidyl peptidase-4 inhibitors (DPP4is) which may not be sustained. Furthermore, there appears a potentially greater glycaemia benefit with use of sodium-glucose transport protein 2 inhibitors (SGLT2is) in Asians compared to whites. Whether such findings are true in all Asians subgroups requires further direct study. For cardiovascular outcomes, available data suggest at least comparable and potentially greater outcome benefits in Asians; point estimates were more favourable for Asians in the vast majority of GLP-1 RAs and SGLT2is outcome trials. It was, however, impossible to determine whether the effects were similar across all Asian subgroups.
We conclude that trialists should be encouraged to record ethnicity with better granularity to allow differing ethnic groups data to be better interrogated. In the meantime, doctors should, where possible, confidently follow newer guidelines for the use of newer glucose lowering agents for treating glycaemia and for the prevention of cardiovascular and cardiorenal complications in South Asian people with type 2 diabetes.
南亚人患 2 型糖尿病的比例更高，发病年龄更早，血糖恶化速度更快，尽管他们的平均体重指数低于白人。现在，糖尿病药物试验的心血管结局结果作为标准报告，新型疗法的数据影响着患者的管理。然而，对于这些疗法在南亚人群中的效果知之甚少。本叙述性综述的目的是尽可能提取这些疗法在南亚人群中的降糖疗效以及心血管和肾脏结局数据。
尽管南亚 2 型糖尿病的患病率和全球负担更高，且结局更差，但他们在全球试验中的代表性仍然不足。即使被招募，目前的种族分类方法通常不允许单独提取和报告南亚人的数据，而是将其与所有亚洲人的数据一起报告。对现有试验数据的分析表明，使用胰高血糖素样肽 1 受体激动剂（GLP-1 RAs）时，亚洲人的血糖和体重变化与其他种族人群大致相当，但使用二肽基肽酶-4 抑制剂（DPP4is）时，血糖获益可能早期出现，但略有增加，尽管这种获益可能无法持续。此外，与白人相比，使用钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2is）可能使亚洲人的血糖获益更大。在所有亚洲亚组人群中是否存在这种发现尚需进一步的直接研究。对于心血管结局，现有数据表明亚洲人的结局获益至少相当，且可能更大；在大多数 GLP-1 RAs 和 SGLT2is 结局试验中，亚洲人的点估计结果更有利。然而，无法确定这些影响在所有亚洲亚组人群中是否相似。
我们的结论是，应该鼓励试验人员更精细地记录种族，以更好地探究不同种族群体的数据。同时，医生应尽可能根据新指南，使用新型降糖药物治疗南亚 2 型糖尿病患者的血糖，并预防心血管和心肾并发症。
