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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 M\u0101ori and Pacific people.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were collected from primary care records for those aged 18\u201375 years with type 2 diabetes (Auckland\/Waikato regions of New Zealand; February 2021 to December 2023;\n                      <jats:italic>n<\/jats:italic>\n                      =59,505). These data were linked to national medication-dispensing and mortality records for 2021\u20132024 via national health identifier numbers. Following propensity matching and Cox modelling for ethnicity, age, gender, medication use, baseline HbA\n                      <jats:sub>1c<\/jats:sub>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 M\u0101ori (HR 0.475; 95% CI 0.336, 0.672;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001), followed by Pacific people (HR 0.507; 95% CI 0.395, 0.651;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001) and European people (HR 0.667; 95% CI 0.545, 0.816;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>The protective effect of SGLT2i use on mortality appears to differ by ethnicity and is greater in Indigenous M\u0101ori and Pacific populations in New Zealand with type 2 diabetes. SGLT2i use in Indigenous and minority populations may support improved health equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06733-2","type":"journal-article","created":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T23:27:39Z","timestamp":1777246059000},"page":"2189-2199","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["SGLT2 inhibitor use and disparities in all-cause mortality in type 2 diabetes: insights from a multi-ethnic population"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9661-4669","authenticated-orcid":false,"given":"Lynne","family":"Chepulis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9676-5291","authenticated-orcid":false,"given":"Han","family":"Gan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Simmons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8312-8525","authenticated-orcid":false,"given":"Rawiri","family":"Keenan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinki","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6002-4766","authenticated-orcid":false,"given":"Tim","family":"Kenealy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8645-3937","authenticated-orcid":false,"given":"Leanne","family":"Te Karu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9507-6096","authenticated-orcid":false,"given":"Dianna","family":"Magliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8490-9072","authenticated-orcid":false,"given":"Jo","family":"Scott-Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Moffitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhuan","family":"Lao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0437-8839","authenticated-orcid":false,"given":"Ross","family":"Lawrenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1579-3870","authenticated-orcid":false,"given":"Ryan G.","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"issue":"2","key":"6733_CR1","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1001\/jamacardio.2020.4511","volume":"6","author":"M Greenberg","year":"2021","unstructured":"Greenberg M, Wang S, Huyck S, Gantz I (2021) Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: a meta-analysis. 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We would also like to thank the Health Research Council of New Zealand for funding this study. We acknowledge that some of these data have previously been presented as an abstract at the Advanced Technologies & Treatments for Diabetes conference meeting in 2025.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"The data that support the findings of this study are available from the corresponding author but restrictions apply to the availability of these data due to patient privacy. These data were supplied and used under licence for the current study and therefore are not publicly available. Data are, however, available from the authors upon reasonable request and with the permission of the Procare, Pinnacle and Hauraki PHOs and the National Hauora Coalition.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"Open Access funding enabled and organized by CAUL and its Member Institutions. This study was funded by the Health Research Council of New Zealand, and the council was not involved in any aspect of study design, data collection, interpretation or dissemination.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"DM is a member of the editorial board of\n                      Diabetologia\n                      . The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"LC is the project lead and co-ordinated data collection and analysis and prepared the primary manuscript draft. HG analysed the data (with methodological support and advice from CL), which were initially compiled by MR. JS-J and AM facilitated access to primary care data. LTK, RP and RK provided cultural and clinical support. TK, RM and RL provided clinical support. LTK, RP, DS, RK, RM, DM and RL contributed to clinical interpretation and manuscript writing. All authors had full access to the data, contributed to the preparation of this manuscript and approved the work for publication. LC is responsible for the integrity of the work as a whole.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}