Abstract
<title>Abstract</title> <p> <bold>Background</bold> South Asians in the United Kingdom experience a disproportionately high burden of type 2 diabetes, with prevalence estimates up to six times higher than other ethnic groups. New-generation glucose-lowering therapies—such as Sodium-Glucose transporter 2 inhibitors and Dipeptidyl peptidase-4 inhibitors—have demonstrated superior efficacy in glycaemic control and reducing diabetes-related complications. However, ethnic disparities in healthcare access and prescribing practices may influence how South Asian patients receive these treatments. <bold>Objectives</bold> To systematically evaluate existing literature on ethnic disparities in the prescribing of novel glucose-lowering medications among South Asian individuals newly diagnosed with type 2 diabetes in the United Kingdom, and to assess inequalities in time to treatment initiation and intensification. <bold>Methods</bold> Systematic searches were conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, and PubMed. Eligible studies included adult South Asian patients with newly diagnosed type 2 diabetes, reported on antidiabetic prescribing patterns, and examined time to initiation or intensification compared to other ethnic groups. Study quality was assessed using the Newcastle-Ottawa Scale for cohort and cross-sectional designs. Data extraction was performed collaboratively by four independent reviewers, and findings were synthesized narratively. <bold>Results</bold> Of 5,969 records screened, four studies met inclusion criteria. South Asian patients showed no delay in therapy initiation but experienced significantly slower treatment intensification compared to White patients (HR 0.80, 95% CI [0.74–0.87], p < 0.001), and greater odds of therapeutic inertia (OR 1.45, 95% CI [1.23–1.70], p < 0.001). Earlier studies reported lower odds of prescribing newer agents such as SGLT2i and DPP-4i to South Asian patients, but more recent evidence suggests these disparities may be diminishing, likely due to evolving clinical guidelines and increased uptake of newer therapies. <bold>Conclusion</bold> South Asian individuals in the United Kingdom face persistent disparities in diabetes treatment intensification, despite equitable initiation of therapy. While historical prescribing patterns reflected inequities in access to newer agents, recent data indicate potential improvements. Continued monitoring and targeted interventions are needed to ensure equitable diabetes care across all stages of treatment. </p>