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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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.