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Patterns and Patients’ Characteristics Associated With Use of Sodium/Glucose Cotransporter 2 Inhibitors Among Adults With Type 2 Diabetes: A Population-based Cohort Study

Published:August 09, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.08.002

      Abstract

      Objectives

      Our aim in this study was to describe patterns and patient-level factors associated with use of sodium/glucose cotransporter 2 inhibitors (SGLT2is) among adults with diabetes being treated in Alberta, Canada.

      Methods

      Using linked administrative data sets from 2014 to 2019, we defined a retrospective cohort of adults with prevalent or incident type 2 diabetes with indications for SGLT2i use and who did not have advanced kidney disease (glomerular filtration rate <30 mL/min per 1.73 m2) or previous amputation. We describe medication dispensation patterns of SGLT2is over time in the overall cohort and among the subgroup with cardiovascular disease (CVD). Multivariable logistic regression was used to determine patients’ characteristics associated with SGLT2i use.

      Results

      Of the 341,827 patients with diabetes (mean age, 60.7 years; 45.6% female), 107,244 (31.3%) had CVD. The proportion of patients with an SGLT2i prescription increased in a linear fashion to a maximum of 10.8% (95% confidence interval [CI], 10.7% to 10.9%) of the eligible cohort by the end of the observation period (March 2019). The proportion of filled prescriptions was similar for patients with CVD (10.4%; 95% CI, 10.1% to 10.6%) and for those without CVD (10.9%; 95% CI, 10.8% to 11.0%). Patients’ characteristics associated with lower odds of filling an SGLT2i prescription included female sex, older age and lower income.

      Conclusions

      The use of SGLT2is is increasing among patients with diabetes but remains low even in those with CVD. Policy and practice changes to increase prescribing for those in whom SGLT2is may help to reduce morbidity and mortality related to cardiovascular and renal complications, particularly older adults.

      Résumé

      Objectifs

      Notre étude visait à décrire les schémas et les facteurs des patients qui sont associés à l’utilisation des inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT2) chez les adultes diabétiques traités en Alberta, au Canada.

      Méthodes

      Au moyen des ensembles de données administratives liées de 2014 à 2019, nous avons défini une cohorte rétrospective d’adultes atteints du diabète de type 2 (cas prévalents ou incidents) qui avaient des indications d’utilisation d’iSGLT2 et qui n’avaient pas d’insuffisance rénale avancée (taux de filtration glomérulaire < 30 ml/min par 1,73 m2) ou d’amputation précédente. Nous avons décrit les schémas de distribution des iSGLT2 au fil du temps dans l’ensemble de la cohorte et le sous-groupe d’adultes atteints d’une maladie cardiovasculaire (MCV). Nous avons utilisé la régression logistique multivariée pour déterminer les caractéristiques des patients associés à l’utilisation des iSGLT2i.

      Résultats

      Parmi les 341 827 patients diabétiques (âge moyen, 60,7 ans; 45,6 % de femmes), 107 244 (31,3 %) avaient une MCV. La proportion de patients qui avaient une ordonnance d’iSGLT2 augmentait de façon linéaire jusqu’à un maximum de 10,8 % (intervalle de confiance [IC] à 95 %, de 10,7 % à 10,9 %) de la cohorte admissible à la fin de la période d’observation (mars 2019). La proportion d’ordonnances exécutées était similaire chez les patients atteints d’une MCV (10,4 %; IC à 95 %, de 10,1 % à 10,6 %) et chez les patients non atteints d’une MCV (10,9 %; IC à 95 %, de 10,8 % à 11,0 %). Les caractéristiques des patients associées à une plus faible probabilité de faire exécuter une ordonnance d’iSGLT2i étaient notamment le sexe féminin, l’âge avancé et le revenu plus faible.

      Conclusions

      L’utilisation des iSGLT2 augmente chez les patients diabétiques, mais demeure faible même chez les patients atteints d’une MCV. Les modifications apportées aux politiques et à la pratique visent à accroître les ordonnances des patients chez lesquels les iSGLT2 peuvent contribuer à réduire la morbidité et la mortalité liées aux complications cardiovasculaires et rénales, particulièrement les personnes âgées.

      Keywords

      Mots clés

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