Elhussein Ahmed, Anderson Andrea, Bancks Michael P, Coday Mace, Knowler William C, Peters Anne, Vaughan Elizabeth M, Maruthur Nisa M, Clark Jeanne M, Pilla Scott
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Lancet Reg Health Am. 2022 Feb;6. doi: 10.1016/j.lana.2021.100111. Epub 2021 Nov 8.
Among patients with type 2 diabetes, minority racial/ethnic groups have a higher burden of cardiovascular disease, chronic kidney disease, and hypoglycaemia. These groups may especially benefit from newer diabetes medication classes, but high cost may limit access. We examined the association of race/ethnicity with the initiation of newer diabetes medications (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors).
We conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) trial including participants with at least one study visit after April 28, 2005. Cox proportional hazards models were used to estimate the association between race/ethnicity and socioeconomic factors with time to initiation of any newer diabetes medication from April 2005 to February 2020. Models were adjusted for demographic and clinical characteristics.
Among 4,892 participants, 63.6%, 15.7%, 12.6%, 5.2%, and 2.9% were White, Black, Hispanic, American Indian or Alaskan Native (AI/AN), or other race/ethnicity, respectively. During a median follow-up of 8.3 years, 2,180 (45.2%) participants were initiated on newer diabetes medications. Race/ethnicity was associated with newer diabetes medication initiation (=.019). Specifically, initiation was lower among Black (HR 0.81, 95% CI 0.70 -0.94) and AI/AN participants (HR 0.51, 95% CI 0.26-0.99). Yearly family income was inversely associated with initiation of newer diabetes medications (HR 0.78, 95% CI 0.62-0.98) comparing the lowest and highest income groups. Findings were mostly driven by GLP-1 receptor agonists.
These findings provide evidence of racial/ethnic disparities in the initiation of newer diabetes medications, independent of socioeconomic factors, which may contribute to worse health outcomes.
在2型糖尿病患者中，少数种族/族裔群体患心血管疾病、慢性肾病和低血糖的负担更高。这些群体可能尤其能从新型糖尿病药物类别中获益，但高昂的成本可能会限制其可及性。我们研究了种族/族裔与新型糖尿病药物（胰高血糖素样肽-1受体激动剂、二肽基肽酶-4抑制剂、钠-葡萄糖协同转运蛋白2抑制剂）起始使用之间的关联。
我们对糖尿病健康行动（Look AHEAD）试验进行了二次分析，纳入了在2005年4月28日之后至少有一次研究访视的参与者。采用Cox比例风险模型来估计种族/族裔和社会经济因素与2005年4月至2020年2月开始使用任何新型糖尿病药物的时间之间的关联。模型对人口统计学和临床特征进行了校正。
在4892名参与者中，分别有63.6%、15.7%、12.6%、5.2%和2.9%为白人、黑人、西班牙裔、美国印第安人或阿拉斯加原住民（AI/AN）或其他种族/族裔。在中位随访8.3年期间，2180名（45.2%）参与者开始使用新型糖尿病药物。种族/族裔与新型糖尿病药物起始使用相关（P = 0.019）。具体而言，黑人（风险比[HR] 0.81，95%置信区间[CI] 0.70 - 0.94）和AI/AN参与者（HR 0.51，95% CI 0.26 - 0.99）的起始使用率较低。比较最低和最高收入组，家庭年收入与新型糖尿病药物起始使用呈负相关（HR 0.78，95% CI 0.62 - 0.98）。研究结果主要由胰高血糖素样肽-1受体激动剂驱动。
这些发现提供了证据，表明在新型糖尿病药物起始使用方面存在种族/族裔差异，且独立于社会经济因素，这可能导致更差的健康结局。
