Cardiorenal Benefits of Newer Glucose-Lowering Drugs by Hispanic Ethnicity: A Meta-analysis of Results from Randomized Outcome Trials in Type 2 Diabetes

Background: Hispanic individuals are at increased risk of diabetes and related complications compared to non-Hispanic White individuals. Thus, we aimed to compare cardiorenal outcomes of newer glucose-lowering drugs between Hispanic and non-Hispanic populations via a meta-analysis of randomized outcome trials. Methods: We included randomized placebo-controlled cardiovascular (CV) and renal outcome trials of SGLT2 inhibitors, GLP-1RAs, and DPP-4 inhibitors that reported major adverse cardiovascular events (MACE) , CV death/heart failure hospitalization (HHF) , or composite renal outcome, stratified by the Hispanic ethnicity (Hispanic vs. non-Hispanic) . We calculated pooled hazard ratios (HR) with 95% CI using fixed-effects models and tested the differences between the two groups (Pinteraction ) . Results: We included outcome trials reporting outcomes by Hispanic ethnicity in 89,393 patients with type 2 diabetes. In three SGLT2 inhibitor trials, the risk of MACE varied by ethnicity (HR = 0.70 [0.54-0.91] in Hispanic population and HR = 0.96 [0.86-1.07] in non-Hispanic population) with a Pinteraction = 0.03, while the risks of CV death/HHF (Pinteraction = 0.46) and composite renal outcome (Pinteraction = 0.31) were similar across ethnicity. In five GLP-1RA trials, we observed a similar MACE risk between Hispanic (HR = 0.82 [0.70-0.96]) and non-Hispanic (HR = 0.92 [0.84-1.00]) populations (Pinteraction = 0.22) . In three DPP-4 inhibitor trials, the risk of MACE was greater in Hispanic (HR=1.15 [0.98-1.35]) than non-Hispanic (HR= 0.96 [0.88-1.04]) populations (Pinteraction = 0.045) , while the risk of composite renal outcome was similar between the two groups (Pinteraction = 0.51) . Conclusion: Compared with non-Hispanic individuals, Hispanics with type 2 diabetes obtain a greater benefit on lowering MACE risk with the use of SGLT2 inhibitors, while a lower benefit with DPP-4 inhibitors. Disclosure H.Tang: None. W.Chen: None. J.Bian: None. L.J.O'neal: None. D.T.Lackland: None. D.Schatz: Advisory Panel; Abbott Diabetes, Medtronic. J.Guo: None.