GLP-1 receptor agonists in lean diabetes in racial and ethnic minority groups: closing the treatment gap

To the Editor: Since their introduction in the early 2000s, glucagon-like peptide-1 (GLP-1) receptor agonists have revolutionised the treatment of type 2 diabetes. Medications such as semaglutide, liraglutide and dulaglutide mimic the action of the naturally occurring hormone GLP-1, resulting in substantial improvements in glycaemic management (mean reductions in HbA1c of 1–2%) and weight loss (5–20%) and a reduced risk of cardiovascular events (12–26%). Additionally, these drugs demonstrate a significant impact on the progression of chronic kidney disease (CKD), reducing the rate of progression to kidney failure by 24% [4]. Because of their multifaceted benefits and favourable safety profile, most recent diabetes management guidelines, including those from the EASD, recommend GLP-1 receptor agonists for certain patient populations. These include individuals with established atherosclerotic cardiovascular disease (ASCVD), CKD or obesity, and those struggling to achieve optimal glycaemic management with other therapies. However, the generalisability of these recommendations to certain populations, such as racial and ethnic minority groups, presents a significant challenge.