No disparity of the efficacy and all‐cause mortality between Asian and non‐Asian type 2 diabetes patients with sodium–glucose cotransporter 2 inhibitors treatment: A meta‐analysis

Abstract

Aims/IntroductionTo evaluate whether there is disparity of the efficacy and all‐cause mortality and other adverse effects between Asian and non‐Asian patients with sodium–glucose cotransporter 2 (SGLT2) inhibitors treatment.Materials and MethodsRandomized clinical trials publicly available before January 2017, comparing SGLT2 inhibitors treatment with a placebo in type 2 diabetes patients were identified. The association between treatment and outcomes was estimated by computing the weighted mean difference for glycated hemoglobin level, blood pressure level, lipid profile levels and bodyweight, and the odds ratios for adverse events.ResultsA total of 17 trials with Asian patients were included and 39 trials with non‐Asian patients were included. Comparison of the glycated hemoglobin decreases corrected by a placebo between Asian and non‐Asian patients showed that there was a non‐significant difference of 0.05% between groups (P > 0.05). Comparisons of the bodyweight changes and blood pressure changes corrected by a placebo between Asian and non‐Asian patients did not show a significant difference between groups (P > 0.05). The risk of all‐cause mortality was not increased when compared with a placebo both in Asian and non‐Asian populations, and the risk of genital infection in Asian and non‐Asian populations were both significant increased.ConclusionsOverall, according to the present meta‐analysis, comparison of the efficacy in SGLT2 inhibitors treatment between Asian and non‐Asian type 2 diabetes patients showed no significant difference in glycated hemoglobin reduction and bodyweight reduction. Furthermore, no disparity was found in the risk of all‐cause mortality or hypoglycemia in SGLT2 inhibitors treatment between Asian and non‐Asian patients.

Clinical relevance between sodium-glucose co-transporter 2 inhibitors and lipid profiles in Asian patients with type 2 diabetes mellitus: a systematic review with a meta-analysis of randomized controlled trials

“…Our results for lipid outcomes were consistent with the meta-analysis by Cai and colleagues [11]; a significant, but small change was observed in lipid outcomes, and these outcomes indicated high heterogeneity (I 2 > 90%). This heterogeneity was attributed to their meta-analysis including RCTs with different inclusion criteria [11]. Total heterogeneity (I 2 ≤ 6%) may also have been attributed to most of the SGLT2i subgroups having low heterogeneity in our analysis.…”

“…To the best of our knowledge, few systematic reviews have examined the effects of SGLT2is on lipid profiles in Asian patients with type 2 diabetes mellitus. A systematic review by Cai and colleagues [11] investigated the effects of SGLT2is in these patients; however, the findings obtained need to be interpreted with caution because the term "Asian patients" used in their metaanalysis indicates that there are 50% or more Asian patients in each RCT selected. We herein conducted a systematic review with a meta-analysis to summarize the available literature and evaluate the clinical relevance between SGLT2is and lipid profiles in Asian patients with type 2 diabetes mellitus.…”

Update on the efficacy and safety of sodium–glucose cotransporter 2 inhibitors in Asians and non‐Asians

“…They found no significant difference in the reduction of glycated hemoglobin or bodyweight. Furthermore, no disparity was found in the risk of all‐cause mortality or hypoglycemia. Subgroup analysis in the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA‐REG OUTCOME) showed that the reductions in the risk of cardiovascular events and mortality by empagliflozin were consistent between Asians and the overall population.…”

“…These pathophysiological differences might have an impact on the therapeutic consideration of SGLT2 inhibitors. Cai et al 5 carried out a meta-analysis to compare the efficacy and adverse effects of SGLT2 inhibitors between Asian and non-Asian type 2 diabetes patients. They found no significant difference in the reduction of glycated hemoglobin or bodyweight.…”

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…Among clinical trials, post hoc analysis of the EMPA-REG and CANVAS clinical trials show that empagliflozin had more cardiovascular benefits in Asians than canagliflozin (in contrast, African Americans had greater cardiovascular benefits with canagliflozin) (257). However, in multiple clinical studies, and notwithstanding a theoretical advantage of glucose-lowering in Asians (who may have more of a b-cell impairment), there were similar clinical efficacy and safety data results with sodium-glucose cotransporter-2 inhibitor (SGLT2i) use among Asians, Caucasians, African Americans/Blacks, and other racial groups (258)(259)(260)(261)(262)(263). In a pharmacogenomics study involving Taiwanese patients with T2D, there were 45 gene variants associated with therapeutic responses to dipeptidyl peptidase-4 inhibitors, with an affirmation that b-cell dysfunction plays more of an etiologic role than insulin resistance in Asians (264).…”