Quality measure and weight loss assessment in patients with type 2 diabetes mellitus treated with canagliflozin or dipeptidyl peptidase-4 inhibitors

BMC Endocrine Disorders

Research Article

Mei Sheng Duh¹  Dominic Pilon²  Marie-Hélène Lafeuille²  Rhiannon Kamstra²  Patrick Lefebvre²  Bruno Emond²  Mike Ingham³  Michael Pfeifer³  Wing Chow⁴  Carol H. Wysham⁵ 

[1] Analysis Group, Inc., Boston, MA, USA;Groupe d’analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, H3B 4W5, Montréal, Québec, Canada;Janssen Scientific Affairs, LLC, Raritan, New Jersey, USA;Johnson & Johnson, New Brunswick, NJ, USA;Rockwood Clinic, Spokane, WA, USA;

关键词: Canagliflozin;    Type 2 diabetes mellitus;    Dipeptidyl peptidase-4 inhibitor;    HbA1c;    Blood pressure;    Weight loss;   

DOI  :  10.1186/s12902-017-0180-8

 received in 2016-12-12, accepted in 2017-05-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAchieving control of glycated hemoglobin (HbA1c), blood pressure (BP), and body weight (BW) remains a challenge for most patients with type 2 diabetes mellitus (T2DM). In clinical trials, canagliflozin (CANA), an inhibitor of sodium-glucose co-transporter 2, has shown significant improvement compared to some dipeptidyl peptidase-4 (DPP-4) inhibitors in the achievement of such quality measures. This study used recent electronic medical records (EMR) data to assess quality measure achievement of HbA1C, BP, and BW loss in patients treated with CANA versus DPP-4 inhibitors.MethodsAdult patients with ≥1 T2DM diagnosis and ≥12 months of clinical activity (baseline) before first CANA or DPP-4 prescription (index) were identified in the QuintilesIMS Health Real-World Data EMRs–US database (03/29/2012–10/30/2015). Patients were observed from the index to last encounter. Inverse probability of treatment weighting (IPTW) was used to adjust for observed baseline confounders between groups. Kaplan-Meier (KM) rates and Cox proportional hazard models were used to compare achievement of HbA1c < 7% (among patients <65 years old), HbA1c < 8%, systolic BP < 140 mmHg, diastolic BP < 90 mmHg, and BW loss ≥ 5% among patients not meeting these respective targets at baseline.ResultsA total of 10,702 CANA and 17,679 DPP-4 patients were selected. IPTW resulted in balanced baseline demographic, comorbidity, and disease characteristics (CANA: N = 13,793, mean age: 59.0 years; DPP-4: N = 14,588, mean age: 58.9 years). Up until 24 months post-index, CANA patients were more likely to reach an HbA1c < 7% (hazard ratio [HR] = 1.10, P = 0.007, KM rates: 42.8% vs. 40.3%), an HbA1c < 8% (HR = 1.16, P < 0.001, KM rates: 63.7% vs. 60.0%), and a BW loss ≥ 5% (HR = 1.46, P < 0.001, KM rates: 55.2% vs. 46.2%), compared to DPP-4 patients. Up until 12 months post-index, CANA patients were more likely to reach a systolic BP < 140 mmHg (HR = 1.07, P = 0.04, KM rates: 87.8% vs. 83.9%). but not a diastolic BP < 90 mmHg (HR = 0.95, P = 0.361), compared to DPP-4 patients.ConclusionsThis retrospective study of EMR data covering up to 30 months after CANA approval (March 2013) suggests that patients initiated on CANA were more likely to reach HbA1c, systolic BP, and weight loss objectives specified by general diabetes care guidelines than patients initiated on DPP-4 inhibitors.

【 授权许可】

CC BY   
© The Author(s). 2017