Introduction
obesity, Obesity, T2D, hyperglycaemia, heart failure, diabetes
OBESITY, OBESITY, RENAL DISEASE, HIGH TRIGLYCERIDES, INSULIN RESISTANCE, ELEVATED TRIGLYCERIDES, HYPERGLYCAEMIA, HEART FAILURE, TYPE 2 DIABETES, DIABETES
The epidemic of type 2 diabetes (T2D) is of significant concern due to increased morbidity, mortality, and health care costs. Current treatment guidelines recommend early use of sodium glucose transport protein 2 inhibitors (SGLT2i) and glucagon like peptide 1 receptor agonists (GLP1RA) for those with high cardiovascular risk, heart failure or renal disease (The glucose lowering response to non-insulin therapies that target discrete aspects of glucose metabolism is, extremely variable between individuals with T2D. Knowledge of which medications are likely to be most effective for individuals with T2D is important to minimise cost, side effects and periods of hyperglycaemia associated with initiating an ineffective medication. In the absence of knowledge about which subgroups of people with T2D respond better to a particular medication, relatively low glucose lowering response to certain treatments may be inappropriately attributed to non-adherence. There is emerging evidence for stratification of glucose lowering response to certain medications for T2D by baseline characteristics, such as ethnicity, obesity and triglyceride levels.Ethnicity as a marker for differential medication responsiveness has been investigated as a simple tool for therapeutic stratification of T2D medications. Both SGLT2i and dipeptidyl peptidase 4 inhibitor (DPP4i) have been reported to be more effective in lowering HbA1c in people of Asian compared with European ethnicity (It is unclear whether differences in treatment response by ethnicity are due to biological differences in underlying T2D aetiology, or whether ethnicity serves as a proxy for residual confounders such as level of glycaemia, concomitant diabetes therapies, dietary factors, medication adherence or other health inequities. Biological differences in underlying T2D aetiology using routinely assessed clinical markers of insulin resistance, such as obesity and/or high triglycerides (OHTG), have been shown to predict less glucose-lowering to DPP4i (Māori are the indigenous people of Aotearoa, New Zealand and share common Polynesian ancestry with Pacific peoples. Obesity and elevated triglyceride levels are prevalent in people of Māori and Pacific ethnicities (