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Patients with type 2 diabetes often need second-line treatments, and this population shows a variety of racial and ethnic disparities. This study analyzed whether these disparities also exist with regard to treatment distribution.

Type 2 diabetes mellitus rates vary by race, with non-White individuals, as well as those with lower income and educational attainment showing a higher prevalence of type 2 diabetes, worse blood glucose control, and earlier onset of macro- and microvascular complications compared to other groups. These minorities also tend to experience delays in treatment, even when it is clinically indicated. Past research has shown a wide variation in clinical practice regarding the choice of second-line oral antidiabetic treatment options. This study, published in Diabetes, Obesity, and Metabolism, sought to determine whether ethnic minorities and those with a higher deprivation status show a lower probability of being prescribed sodium-glucose cotransporter 2 (SGLT2) inhibitors compared with dipeptidyl peptidase-4 (DPP-4) inhibitors or low-cost sulphonylureas (SUs). 

Measuring Second-Line Diabetes Treatments by Ethnicity

This study relied on linked primary and secondary care data, as well as the Index of Multiple Deprivation (IMD). All data referred to individuals older than 18 with type 2 diabetes in England who intensified to second-line oral antidiabetic medication between 2014 and 2020. White, South Asian, Black, and mixed/other ethnicities were used, along with deprivation via IMD quintiles. The authors found that among 36,023 people included, 85% were White, 10% were South Asian, 4% were Black, and 1% were mixed/other. A small, but statistically significant difference was found in SU, DPP-4 inhibitor, and SGLT2 inhibitor prescription, according to ethnicity and deprivation level. 

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Diabetes-Related Ethnic Disparities Persist, but Second-Line Treatments Are Equally Distributed

The authors conclude by noting that, although there are several other racial disparities among those with type 2 diabetes, there is no substantial difference in second-line antidiabetic treatment prescription. In the single-payer healthcare system of England ethnic minorities face longer delays in treatment intensification and second-line treatment compared to White patients. Additionally, the data does show that patients with cardiovascular disease have a lower probability of receiving SGLT2 inhibitors versus those without, even though SGLT2 inhibitors have shown substantial improvements in diabetic-related outcomes among those with cardiovascular disease and kidney disease. Because guidelines relating to the use of these treatment options are changing, further research is needed to give a more up-to-date picture of how these treatments are distributed.


Bidulka, P., Mathur, R., Lugo-Palacios, D. G., O’Neill, S., Basu, A., Silverwood, R. J., Charlton, P., Briggs, A., Smeeth, L., Adler, A. I., Douglas, I. J., Khunti, K., & Grieve, R. (2023). Ethnic and socioeconomic disparities in initiation of second-line antidiabetic treatment for people with type 2 diabetes in England: A cross-sectional study. Diabetes, Obesity & Metabolism, 25(1), 282-292. https://doi.org/10.1111/dom.14874