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, especially
in older adults, may help to reduce morbidity and mortality related to cardiovascular
and renal complications.
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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References
- At-a-glance---twenty years of diabetes surveillance using the Canadian Chronic Disease Surveillance System.Health Promot Chronic Disease Prev Canada Res Policy Pract. 2019; 39: 306-309
- Epidemiology of diabetes mellitus and cardiovascular disease.Curr Cardiol Rep. 2019; 21: 21
- Economic burden of cardiovascular disease in type 2 diabetes: A systematic review.Value Health. 2018; 21: 881-890
- Health Canada. Product information.https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=91013#fn1Date accessed: November 15, 2021
- Canagliflozin and cardiovascular and renal events in type 2 diabetes.N Engl J Med. 2017; 377: 644-657
- Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.N Engl J Med. 2015; 373: 2117-2128
- Dapagliflozin and cardiovascular outcomes in type 2 diabetes.N Engl J Med. 2019; 380: 347-357
- Using real world data to assess cardiovascular outcomes of two antidiabetic treatment classes.World J Diabetes. 2018; 9: 252-257
- Real-world use and modeled impact of glucose-lowering therapies evaluated in recent cardiovascular outcomes trials: An NCDR® Research to Practice project.Eur J Prev Cardiol. 2017; 24: 1637-1645
- Use of guideline-recommended risk reduction strategies among patients with diabetes and atherosclerotic cardiovascular disease insights from getting to an improved understanding of low-density lipoprotein cholesterol and dyslipidemia management (GOULD).Circulation. 2019; 140: 618-620
- Use of lipid-, blood pressure–, and glucose-lowering pharmacotherapy in patients with type 2 diabetes and atherosclerotic cardiovascular disease.JAMA Netw Open. 2022; 5e2148030
- Trends in clinical characteristics and prescribing preferences for SGLT2 inhibitors and GLP-1 receptor agonists, 2013–2018.Diabetes Care. 2020; 43: 921-924
- Alberta Blue Cross. Interactive drug benefit list.https://idbl.ab.bluecross.ca/idbl/lookupdinpindetail.do?productid=0000072966Date accessed: November 15, 2021
- Association of race/ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with diabetes in the US.JAMA Netw Open. 2021; 4: 1-13
- Cost effectiveness of sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors: A systematic review.Pharmacoeconomics. 2019; 37: 777-818
- Alberta Diabetes Link. Insurance coverage for diabetes prescription therapies.http://albertadiabeteslink.ca/process.php?docname=diabetes-medication-coverage-sheet-2018-1.pdfDate accessed: November 23, 2021
- Health Analytics Branch--Alberta Health. Overview of administrative health datasets.(2017.)http://www.health.alberta.ca/documents/research-health-datasets.pdfDate: 2017Date accessed: November 21, 2021
- Overview of the Alberta Kidney Disease Network.BMC Nephrol. 2009; 10: 1-7
- Association of enrolment in primary care networks with diabetes care and outcomes among First Nations and low-income Albertans.Open Med. 2012; 6: 155-165
- Enrolment in primary care networks: Impact on outcomes and processes of care for patients with diabetes.CMAJ. 2012; 184: 144-152
- Alberta Blue Cross. DPP-4/SGLT2 inhibitors/GLP-1 receptor agonists special authorization request form.https://www.ab.bluecross.ca/dbl/pdfs/60012.pdfDate accessed: November 23, 2021
- Incidence and prevalence of diabetes in Manitoba, 1986–1991.Diabetes Care. 1996; 19: 807-811
- Diabetes in Ontario: Determination of prevalence and incidence using a validated administrative data algorithm.Diabetes Care. 2002; 25: 512-516
- Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease.CMAJ. 2019; 191: E955-E961
- Policies, guidelines and consensus statements: Pharmacologic management of type 2 diabetes---2015 interim update.Can J Diabetes. 2015; 39: 250-252
- Validation of a type 1 diabetes algorithm using electronic medical records and administrative healthcare data to study the population incidence and prevalence of type 1 diabetes in Ontario, Canada.BMJ Open Diabetes Res Care. 2020; 8: 1-11
- Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.Health Serv Res. 2008; 43: 1424-1441
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Med Care. 2005; 43: 1130-1139
- A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario.Am Heart J. 2002; 144: 290-296
- Coding of stroke and stroke risk factors using International Classification of Diseases, revisions 9 and 10.Stroke. 2005; 36: 1776-1781
- Validation of physician billing and hospitalization data to identify patients with ischemic heart disease using data from the Electronic Medical Record Administrative data Linked Database (EMRALD).Can J Cardiol. 2010; 26: 225-228
- Methods for identifying 30 chronic conditions: Application to administrative data Healthcare Information Systems.BMC Med Inform Decis Mak. 2015; 15: 31
- Association between change in physician remuneration and use of peritoneal dialysis: A population-based cohort analysis.CMAJ Open. 2020; 8: E96-E104
- Alberta Health Services. Official standard geographic areas. January.
- Defining and measuring interpersonal continuity of care.Ann Fam Med. 2003; 1: 134-143
- Assessment of second-generation diabetes medication initiation among medicare enrollees from 2007 to 2015.JAMA Netw Open. 2020; 3e205411
- Use of SGLT2 inhibitors in older adults: Scientific evidence and practical aspects.Drugs Aging. 2020; 37: 399-409
- Prescribing of SGLT2 inhibitors in primary care: A qualitative study of general practitioners and endocrinologists.Diabetes Res Clin Pract. 2021; 180109036
- Pharmacologic glycemic management of type 2 diabetes in adults: 2020 update.Can J Diabetes. 2020; 44: 575-591
Article info
Publication history
Published online: August 09, 2022
Accepted:
August 3,
2022
Received in revised form:
July 20,
2022
Received:
January 17,
2022
Identification
Copyright
© 2022 Canadian Diabetes Association.
