Abstract
BackgroundCanagliflozin, an oral agent that inhibits sodium glucose co-transporter 2, improves glycemic control, body weight, and blood pressure and is generally well tolerated in patients with type 2 diabetes mellitus (T2DM). This study extends the scope of previous analyses by evaluating outcomes associated with the use of canagliflozin over a 6-month period in a real-world setting.MethodsThis retrospective cohort study used data obtained from a large health plan database for patients (≥18 years) with a diagnosis of T2DM who filled at least one canagliflozin prescription between April 1, 2013 and October 30, 2013 (first 7 months canagliflozin was commercially available in the USA) and were continuously enrolled in the health plan for 6 months prior to (baseline) and 6 months following the first canagliflozin prescription claim (follow-up). Changes in glycemic control were evaluated, along with characteristics of enrolled patients and changes in treatment patterns.Results4017 patients (mean age 56 years, 43 % female) met the study inclusion criteria. Of these, at the time of first canagliflozin claim, 21 % used canagliflozin concomitantly with three or more other antihyperglycemic agents (AHAs), 29 % with two other AHAs, 30 % with one other AHA, and 20 % without other AHAs. During follow-up, patients received 3.4 (average) canagliflozin prescription fills and a mean of 148 total days of supply; median adherence (interquartile range [IQR]) was 86 % (66–98 %) for patients with ≥2 fills. Among patients with available glycated hemoglobin (A1C) measurements at baseline and follow-up (n = 826, baseline A1C 8.59 %), mean A1C reduction was 0.81 % (P < 0.001). Mean A1C reduction during the follow-up period was greatest in patients with the highest baseline A1C levels. Of the patients who used canagliflozin concomitantly with other AHAs, 20 % were observed to discontinue one or more other AHAs during follow-up. The most commonly discontinued baseline AHAs were: glucagon-like peptide-1 receptor agonists (16 %), dipeptidyl peptidase-4 inhibitors (15 %), insulin (13 %), sulfonylureas (13 %), and metformin (11 %).ConclusionsThis real-world study on canagliflozin use in a range of patients with T2DM demonstrated significant improvements in mean A1C from baseline following the first canagliflozin prescription. In patients concomitantly using one or more additional AHAs at baseline, there appears to be a trend toward lower other AHA use after canagliflozin initiation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-015-0064-8) contains supplementary material, which is available to authorized users.
Highlights
Canagliflozin, an oral agent that inhibits sodium glucose co-transporter 2, improves glycemic control, body weight, and blood pressure and is generally well tolerated in patients with type 2 diabetes mellitus (T2DM)
This study indicates that treatment of T2DM with canagliflozin in a real-world population is associated with substantial reductions in glycated hemoglobin (A1C) and an increase in the proportion of patients attaining A1C targets
Since the plans used for analysis include a wide geographic distribution across the USA, they provide the capability for generalization to managed-care populations on a national level. In this real-world study of canagliflozin use during the period immediately following Food and Drug Administration (FDA) approval, canagliflozin was prescribed to patients with a range of baseline A1C values whose glycemic levels were often uncontrolled (87 % with A1C ≥7.0 %) despite being managed with multiple antihyperglycemic agent (AHA), including insulin therapy
Summary
Canagliflozin, an oral agent that inhibits sodium glucose co-transporter 2, improves glycemic control, body weight, and blood pressure and is generally well tolerated in patients with type 2 diabetes mellitus (T2DM). The management of type 2 diabetes mellitus (T2DM) involves lowering of blood glucose levels, together with reducing cardiovascular and microvascular risk factors, i.e., blood pressure- and lipid-lowering therapy, antiplatelet treatment, smoking cessation, and weight loss depending on the needs, preferences, and tolerances of each patient [1, 2]. The progressive nature of the disease means that most patients require increasingly intensive pharmacologic interventions. Tight glycemic control, defined as mean glycated hemoglobin (A1C)
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