Data Science
Age and sex differences in diabetes treatments
The challenge
Drugs used to treat type 2 diabetes aim to reduce blood sugar levels, and some of these medications also reduce the risk of heart attacks and strokes. We wanted to understand if the efficacy of treatments for type 2 diabetes varied depending on age and sex. Randomised controlled trials give the most internally valid estimates of the efficacy of medical treatments, however individual trials are too small to allow precise estimates of whether treatment effect vary depending on characteristics such as age and sex. Meta-analysis, where findings from multiple trials are combined, gives more precise results. However, to give the most reliable results for how the effect of treatment differs by individual characteristics (such as age and sex) is necessary to include analysis of individual participant data.
The research
The study team identified 601 randomised controlled trials of treatments for type 2 diabetes. They then obtained and analysed the original individual participant data for 103 of these trials. This was facilitated through Vivli, who operate a platform through which pharmaceutical companies can safely and securely share their data. The researchers then combined the published findings with analysis of the individual participant data to assess whether the efficacy of type 2 diabetes treatments varied by age and sex.
The results
For one class of medications, Sodium Glucose Co-transporter 2 (SGLT2) inhibitors, there were important differences in efficacy depending on participants age. These drugs reduce blood sugar and reduce the risk of cardiovascular outcomes (such as heart attacks and strokes) overall. The analysis showed that the cardiovascular benefits of SGLT2 inhibitors were even greater in older compared to younger people. This was despite the fact that the glucose-lowering effects of SGLT2 inhibitors were lower in older compared to younger people.
The impact
These findings show that older people may have potential to benefit more from treatment with SGLT2 inhibitors, which are increasingly used in clinical practice to treat type 2 diabetes. These findings also suggest that clinicians need not be put off by relatively smaller improvements in blood sugar in older people, as the improved cardiovascular outcomes were seen despite smaller improvements in blood sugar. This research would not have been possible without access and analysing individual participant data from these trials.
Lead
Read the paper
The study, Age and sex differences in efficacy of treatments for type 2 diabetes: A network meta-analysis, is published in JAMA.
