Health disparities in diabetes treatment: The challenge of G6PD deficiency

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-01-01 DOI:10.1016/j.diabres.2024.111965

Ariel Israel , Itamar Raz , Ilan Green , Avivit Golan-Cohen , Matitiahu Berkovitch , Eli Magen , Shlomo Vinker , Eugene Merzon

{"title":"Health disparities in diabetes treatment: The challenge of G6PD deficiency","authors":"Ariel Israel , Itamar Raz , Ilan Green , Avivit Golan-Cohen , Matitiahu Berkovitch , Eli Magen , Shlomo Vinker , Eugene Merzon","doi":"10.1016/j.diabres.2024.111965","DOIUrl":null,"url":null,"abstract":"<div><h3>Aims</h3><div>To assess the impact of Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an enzymatic deficiency prevalent in individuals of African or Asian descent, on Hemoglobin A1c (HbA1c) levels, diabetes medication purchases, and the cumulative incidence of diabetes related complications.</div></div><div><h3>Methods</h3><div>A large cohort study was conducted within a national health organization, comparing 3,913 G6PD-deficient patients to a matched control group without G6PD deficiency over two decades. The main measures and outcomes were the HbA1c levels, patterns of diabetes medication purchases, and the incidence of severe diabetes-related complications.</div></div><div><h3>Results</h3><div>HbA1c levels significantly underestimated blood glucose concentrations in G6PD-deficient individuals. Individuals with diabetes and G6PD deficiency had lower rates of treatment with most diabetes medications, notably GLP-1 receptor agonists and SGLT2 inhibitors. Severe diabetes-related complications were more frequent among G6PD-deficient patients, with adjusted hazards ratios [95% confidence intervals] of 1.44 [1.16–1.81] for severe kidney insufficiency, 1.75 [1.23–2.49] for myocardial infarction, and 1.27 [1.02–1.58] for neuropathy.</div></div><div><h3>Conclusions</h3><div>This research highlights serious gaps in the management of G6PD-deficient patients with diabetes, who suffer from insufficient medication management and higher rates of complications. These findings underscore the need to account for G6PD deficiency in diabetes treatment to ensure equitable and effective healthcare for this vulnerable population.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"219 ","pages":"Article 111965"},"PeriodicalIF":6.1000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes research and clinical practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0168822724008751","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Aims

To assess the impact of Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an enzymatic deficiency prevalent in individuals of African or Asian descent, on Hemoglobin A1c (HbA1c) levels, diabetes medication purchases, and the cumulative incidence of diabetes related complications.

Methods

A large cohort study was conducted within a national health organization, comparing 3,913 G6PD-deficient patients to a matched control group without G6PD deficiency over two decades. The main measures and outcomes were the HbA1c levels, patterns of diabetes medication purchases, and the incidence of severe diabetes-related complications.

Results

HbA1c levels significantly underestimated blood glucose concentrations in G6PD-deficient individuals. Individuals with diabetes and G6PD deficiency had lower rates of treatment with most diabetes medications, notably GLP-1 receptor agonists and SGLT2 inhibitors. Severe diabetes-related complications were more frequent among G6PD-deficient patients, with adjusted hazards ratios [95% confidence intervals] of 1.44 [1.16–1.81] for severe kidney insufficiency, 1.75 [1.23–2.49] for myocardial infarction, and 1.27 [1.02–1.58] for neuropathy.

Conclusions

This research highlights serious gaps in the management of G6PD-deficient patients with diabetes, who suffer from insufficient medication management and higher rates of complications. These findings underscore the need to account for G6PD deficiency in diabetes treatment to ensure equitable and effective healthcare for this vulnerable population.

查看原文本刊更多论文

糖尿病治疗中的健康差异：G6PD缺乏症的挑战

目的：评估葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症（一种普遍存在于非洲或亚洲血统的酶缺乏症）对血红蛋白A1c （HbA1c）水平、糖尿病药物购买和糖尿病相关并发症累积发生率的影响。方法：在一个国家卫生组织内进行了一项大型队列研究，比较了3913名G6PD缺陷患者和20多年来没有G6PD缺陷的匹配对照组。主要测量和结果是HbA1c水平、糖尿病药物购买模式和严重糖尿病相关并发症的发生率。结果：HbA1c水平显著低估了g6pd缺乏个体的血糖浓度。糖尿病和G6PD缺乏症患者接受大多数糖尿病药物治疗的几率较低，尤其是GLP-1受体激动剂和SGLT2抑制剂。严重糖尿病相关并发症在g6pd缺乏患者中更为常见，严重肾功能不全的校正危险比[95%可信区间]为1.44[1.16-1.81]，心肌梗死的校正危险比为1.75[1.23-2.49]，神经病变的校正危险比为1.27[1.02-1.58]。结论：本研究突出了g6pd缺陷糖尿病患者治疗方面的严重差距，这些患者的药物治疗不足，并发症发生率较高。这些发现强调了在糖尿病治疗中考虑G6PD缺乏的必要性，以确保这一弱势群体获得公平有效的医疗保健。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.