The University of Waikato has released groundbreaking research demonstrating the profound life-saving benefits of sodium-glucose co-transporter 2 (SGLT2) inhibitors for people with type 2 diabetes, particularly within Māori and Pacific communities. The study, published in the journal Diabetologia, analysed health records from nearly 60,000 adults across the Auckland and Waikato regions and found that these medications deliver the greatest reduction in mortality risk for Indigenous and minority populations.
Understanding Type 2 Diabetes and Health Disparities in New Zealand
Type 2 diabetes is a chronic condition in which the body becomes resistant to insulin or does not produce enough of the hormone, leading to elevated blood glucose levels. In Aotearoa New Zealand, the disease disproportionately affects Māori and Pacific peoples, who often develop it at younger ages and experience higher rates of complications such as cardiovascular disease, kidney failure, and premature death. These inequities stem from a combination of genetic predispositions, socioeconomic factors, limited access to culturally appropriate care, and historical systemic barriers in the health system.
Primary care data reveal that Māori and Pacific adults with type 2 diabetes face elevated risks compared with other ethnic groups. Addressing these gaps requires targeted interventions that prioritise equity alongside clinical effectiveness.
The Role of SGLT2 Inhibitors in Modern Diabetes Care
SGLT2 inhibitors represent a class of medications that work by blocking the reabsorption of glucose in the kidneys, promoting its excretion through urine. Beyond lowering blood sugar, they offer significant cardiovascular and renal protection, reducing hospitalisations for heart failure and slowing the progression of kidney disease. Empagliflozin, the primary SGLT2 inhibitor funded in New Zealand, exemplifies these benefits and has become a cornerstone of updated treatment guidelines worldwide.
Unlike older diabetes therapies focused solely on glycaemic control, SGLT2 inhibitors address multiple pathways of disease, making them particularly valuable for populations with high rates of comorbid conditions.
Pharmac’s 2021 Funding Decision and Ethnicity Criteria
In February 2021, Pharmac, New Zealand’s pharmaceutical funding agency, introduced special authority criteria that prioritised access to SGLT2 inhibitors and GLP-1 receptor agonists for Māori, Pacific peoples, and individuals with established cardiovascular or renal disease or risk factors. This policy aimed to close longstanding equity gaps by ensuring faster access for those most affected.
The decision sparked debate at the time, with some questioning the use of ethnicity in eligibility rules. Subsequent real-world evidence has validated the approach, showing improved uptake among the prioritised groups.
Key Findings from the Waikato University Study
Led by Dr Lynne Chepulis from the University of Waikato’s Medical Research Centre, the research team examined primary care records from four large primary health organisations covering approximately 302 general practices. The cohort included 59,505 adults aged 18–75 with type 2 diabetes, of whom 12,189 identified as Māori and 10,706 as Pacific.
Researchers compared mortality outcomes between those dispensed SGLT2 inhibitors and matched individuals who were not, adjusting for factors including ethnicity, cardiovascular or renal disease status, age, baseline HbA1c, and gender. Annualised crude mortality rates were substantially lower among users of the medication: 13.1 versus 35.2 deaths per 1,000 person-years in those with cardiovascular or renal disease, and 3.6 versus 7.7 in those without.
After full adjustment, the hazard ratio for all-cause mortality with SGLT2 inhibitor use was 0.475 for Māori, 0.507 for Pacific peoples, and 0.667 for Europeans. These figures indicate that the protective effect was strongest in the Indigenous and Pacific groups, directly supporting the equity-focused funding criteria.
Implications for Health Equity and Policy
The results underscore how targeted access policies can narrow disparities. Māori and Pacific patients showed higher initiation rates under the prioritised criteria, helping to offset historical under-treatment. The study authors emphasise that removing ethnicity-based prioritisation could reverse these gains, particularly as Pharmac considers adjustments to the special authority criteria.
Broader health system factors also influence outcomes. Practices with higher doctor-to-patient ratios, lower fees, and Māori health providers achieved better prescribing rates, highlighting the importance of culturally safe and accessible primary care.
The University of Waikato’s Contribution to Diabetes Research
As a leading research institution in the Waikato region, the University of Waikato has built significant expertise in health equity and diabetes management. Its Medical Research Centre collaborates with Health New Zealand, primary care networks, and international partners including the University of Western Sydney and Monash University. This study exemplifies the university’s commitment to producing actionable evidence that informs national policy and improves outcomes for underserved communities.
Faculty members such as Dr Lynne Chepulis and Dr Ryan Paul bring both clinical and cultural expertise, ensuring research questions are framed with community priorities in mind.
Stakeholder Perspectives and Real-World Impact
Clinicians and community leaders have welcomed the findings. Endocrinologists note that the medications not only save lives but also reduce the burden of complications that disproportionately affect Māori and Pacific whānau. Patients report improved energy, better kidney function, and reduced hospital visits, translating into stronger family and community participation.
Health New Zealand and primary care organisations highlight the need for sustained investment in workforce training and culturally tailored education to maintain high uptake rates.
Photo by Marcel Strauß on Unsplash
Future Outlook and Recommendations
With type 2 diabetes prevalence continuing to rise, expanding appropriate use of SGLT2 inhibitors remains a priority. The Waikato research team recommends retaining ethnicity criteria while addressing remaining barriers such as cost, transport, and health literacy. Ongoing monitoring through primary care datasets will be essential to track long-term outcomes and refine policies.
Universities like Waikato are well positioned to lead further studies on implementation science, digital health tools, and community-led interventions that complement pharmacological advances.
Conclusion
The University of Waikato’s latest study provides compelling evidence that equitable access to SGLT2 inhibitors is delivering measurable life-saving benefits, especially for Māori and Pacific communities. As policymakers weigh future funding decisions, this research offers a clear, data-driven case for maintaining and strengthening targeted approaches that address New Zealand’s unique health equity challenges.