Ethnic differences in the comparative effectiveness of second‐line type 2 diabetes medications in preventing cardiovascular disease
Authors' conclusion
We found weak evidence suggesting a greater effect of DPP4i than SUs against MACE in Black people, particularly for heart failure hospitalisation, but no evidence of other ethnic differences in treatment effects.
Study context
- Population
- Adults with T2D initiating sulfonylureas (SU), DPP4i or SGLT2i (2015–2022), UK electronic health records; 72.3% White, 14.2% South Asian, 6.0% Black
- Participants
- 91,116 adults
- Exposure
- DPP4i vs SU, SGLT2i vs SU and SGLT2i vs DPP4i, by ethnicity
- Outcome
- MACE: MI, stroke, HF hospitalisation, cardiovascular death
Methodological detailsUK electronic health records, Cox models, Wald tests for interaction by ethnicity, Initiation: SU 34.2%, DPP4i 42.0%, SGLT2i 23.8%
- UK electronic health records
- Cox models
- Wald tests for interaction by ethnicity
- Initiation: SU 34.2%, DPP4i 42.0%, SGLT2i 23.8%
Main finding
As reported in the abstract
MACE, DPP4i vs SU by ethnicity
DPP4i vs SUHazard ratio (95% CI)
Black
0.64(0.46–0.89)
White
0.91(0.84–0.98)
South Asian
0.93(0.75–1.16)
- Interaction by ethnicity (weak evidence)
- P = 0.12
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| HF hospitalisation, DPP4ivs SU by ethnicityBlack | 0.50 (0.30–0.84) | |
| 0.20.5125Hazard ratio (log scale) |
- HF hospitalisation, DPP4i vs SU by ethnicity — Interaction by ethnicity
- p = 0.05
Other treatment comparators and cardiovascular outcomes
- No clear evidence of ethnic differences
Original publication
Ethnic differences in the comparative effectiveness of second‐line type 2 diabetes medications in preventing cardiovascular disease. Diabetes Obes Metab. Published 12 November 2025. doi:10.
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