Ananthesh L, Cutinha Rasheal Maria, Basutkar Roopa Satyanarayan
Nitte (Deemed to be University) NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Department of Pharmacy Practice, Mangalore, India.
J Racial Ethn Health Disparities. 2025 Apr 21. doi: 10.1007/s40615-025-02410-z.
The newer classes of anti-diabetes medications have additional cardiovascular and renal effects, and restricted access would contribute to diabetes-related healthcare disparities. Hence, a systematic review, and meta-analysis, was undertaken to determine the existence of racial and ethnic disparities in the uptake of SGLT2i or GLP-1 RA.
The search was performed using Scopus, Cochrane Central Registry of Controlled Trials, PubMed, and Web of Science databases. Eligibility to include the studies was assessed independently, and this review included observational studies. The necessary information was extracted using the Cochrane-modified data extraction form. The quality of the studies was assessed using the Newcastle-Ottawa scale. RevMan v5.4.1 was used to conduct the analysis. The certainty of the evidence was measured with GradePro.
The likelihood of prescription fills with SGLT2i and GLP-1 RA was lower among the Black population, with odds ratios (OR) of 0.81 (95% CI 0.75-0.88, p < 0.0001) for SGLT2i and 0.78 (95% CI 0.70-0.87, p < 0.0001) for GLP-1 RA when compared to White population. Additionally, Asian individuals and those classified under "Other" populations had a significant reduction in GLP-1 RA prescription fills, with odds ratios of 0.61 (95% CI 0.43-0.86) and 0.73 (95% CI 0.60-0.89), respectively. However, there was no significant difference in SGLT2i prescription fills among the Asian individuals (p = 0.56) or those in the "Other" population category (p = 0.51).
The extent of evidence-based practice in prescribing SGLT2i was significantly low among the Black population compared to patients who are Whites. The number of prescriptions filled by GLP-1 RA was significantly low among the Asian population, the Black population, and other populations. Thus, policymakers and clinicians must take the necessary initiatives to achieve pharmacoequity in managing T2DM with co-morbidity conditions.
新型抗糖尿病药物具有额外的心血管和肾脏效应，而获取受限会加剧与糖尿病相关的医疗保健差距。因此，开展了一项系统评价和荟萃分析，以确定在钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）或胰高血糖素样肽-1受体激动剂（GLP-1 RA）的使用方面是否存在种族和民族差异。
使用Scopus、Cochrane对照试验中央注册库、PubMed和Web of Science数据库进行检索。独立评估纳入研究的资格，本评价纳入观察性研究。使用Cochrane修改的数据提取表提取必要信息。使用纽卡斯尔-渥太华量表评估研究质量。使用RevMan v5.4.1进行分析。使用GradePro衡量证据的确定性。
与白人相比，黑人人群中SGLT2i和GLP-1 RA的处方配药可能性较低，SGLT2i的比值比（OR）为0.81（95%置信区间0.75-0.88，p<0.0001），GLP-1 RA的比值比为0.78（95%置信区间0.70-0.87，p<0.0001）。此外，亚洲人和归类为“其他”人群的个体的GLP-1 RA处方配药显著减少，比值比分别为0.61（95%置信区间0.43-0.86）和0.73（95%置信区间0.60-0.89）。然而，亚洲个体（p=0.56）或“其他”人群类别中的个体（p=0.51）在SGLT2i处方配药方面没有显著差异。
与白人患者相比，黑人人群中开具SGLT2i的循证实践程度显著较低。亚洲人群、黑人人群和其他人群中GLP-1 RA的处方配药数量显著较低。因此，政策制定者和临床医生必须采取必要措施，在管理伴有合并症的2型糖尿病时实现药物公平。
