Leanne Te Karu

Aims/hypothesis: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known to reduce cardiovascular and all-cause mortality in people with type 2 diabetes, but there are limited data regarding mortality outcomes in different ethnic groups (including Indigenous peoples). This study reports on mortality outcomes in a population in Aotearoa New Zealand (hereafter New Zealand) with type 2 diabetes, following the funded availability of the SGLT2i empagliflozin with prioritised access for Māori and Pacific people. Methods: Data were collected from primary care records for those aged 18–75 years with type 2 diabetes (Auckland/Waikato regions of New Zealand; February 2021 to December 2023; n =59,505). These data were linked to national medication-dispensing and mortality records for 2021–2024 via national health identifier numbers. Following propensity matching and Cox modelling for ethnicity, age, gender, medication use, baseline HbA _1c and cardiovascular and/or renal disease/risk (CVRD) status (yes/no), mortality rates were compared by ethnicity in those with and without CVRD and who did/did not initiate empagliflozin. This study was reported in accordance with the CONSIDER statement, used to strengthen the reporting of research involving Indigenous peoples. The study was funded by the Health Research Council of New Zealand. Results: Following matching, two groups of 12,792 individuals were identified. Annualised crude mortality (deaths per 1000 individuals per year) was higher in those not dispensed with SGLT2i than in those receiving SGLT2i (35.2 vs 13.1 in those with CVRD and 7.7 vs 3.6 in those without CVRD, respectively). After adjustment, the greatest difference in mortality with SGLT2i use was seen in Māori (HR 0.475; 95% CI 0.336, 0.672; p p p <0.001). Conclusions/interpretation: The protective effect of SGLT2i use on mortality appears to differ by ethnicity and is greater in Indigenous Māori and Pacific populations in New Zealand with type 2 diabetes. SGLT2i use in Indigenous and minority populations may support improved health equity.

Aim: To explore the views of general practitioners (GPs) and nurses on type 2 diabetes (T2D) management, including the use of recently funded T2D medications in New Zealand (NZ) and their perceived barriers to providing optimal care. Background: T2D is a significant health concern in NZ, particularly among Māori and Pacific adults. Characterised by prolonged hyperglycaemia, T2D is generally a progressive condition requiring long-term care. Methods: Semi-structured interviews were conducted between July and December 2022 with 21 primary care clinicians (10 GPs and 11 nurses/nurse prescribers) from nine different general practice clinics across the Auckland and Waikato regions of NZ. Framework analysis was conducted to identify common themes in clinicians’ perceptions and experiences with T2D management. Findings: Three themes were identified: health-system factors, new medications, and solution-based approaches. Lack of clinician time, healthcare funding, staff shortages, and burn-out were identified as barriers to T2D management under health-system factors. The two newly funded medications, empagliflozin and dulaglutide, were deemed to be a positive change for T2D care in that they improved patient satisfaction and clinical outcomes, but several clinicians were hesitant to prescribe these medications. Participants suggested that additional education and specialist diabetes support would be helpful to inform optimal medication prescribing and that better use of a multi-disciplinary team (clinical and support staff) could support T2D care by reducing workload, addressing cultural gaps in healthcare delivery, and reducing burnout. An improved primary care work environment, including appropriate professional development to support prescribing of new medications and the value of collaboration with a non-regulated workforce, may be required to facilitate optimal T2D management in primary care. Future research should focus on interventions to increase support for both clinical teams and patients while adopting a culturally appropriate approach to increase patient satisfaction and improve health outcomes.

Patients9 drawings of their illnesses have been used as a unique way of assessing illness perceptions in a wide range of diseases, including cardiac, respiratory, endocrine, and neurological conditions. ^1,2 Patient drawings can reveal beliefs about the extent and effect of their illness that are hard to capture and interpret using standard questionnaires.