Canagliflozin treatment of Hispanic and non-Hispanic patients with type 2 diabetes in a US managed care setting

Abstract

Background:

Hispanic/Latino (H/L) ethnicity is associated with higher prevalence of type 2 diabetes mellitus (T2DM) and more complications and comorbidities. Few studies of antihyperglycemic agents (AHAs) have compared H/L with non-H/L patients. Randomized controlled trials and observational studies have shown canagliflozin (CANA) is effective at lowering hemoglobin A1C (A1C).

Objective:

To describe characteristics and compare glycemic control between H/L and non-H/L patients with T2DM filling their first prescription for CANA.

Methods:

This retrospective cohort study examined healthcare claims for diabetic patients who filled ≥1 prescription for CANA between 1 April 2013 and 31 October 2013. We captured available demographic data; ethnicity was imputed as previously published. Clinical data included the Diabetes Complications Severity Index (DCSI), A1C values, and claims for any AHA, with 6 months of follow-up.

Results:

Our sample included 438 (11.4%) H/L individuals and 3408 (88.6%) non-H/L individuals; each cohort had 43% females. The H/L patients were younger (53 vs. 56 years, p < 0.001) with higher mean baseline A1C (8.9% vs. 8.5%, respectively; p = 0.028) compared to non-H/L patients. Mean DCSI was similar (H/L 0.92 vs. non-H/L 0.84, p = 0.289) between cohorts. More H/L patients (25%) were taking ≥3 AHAs at the first CANA prescription fill (vs. 21% for non-H/L; p = 0.044), most commonly metformin, followed by sulfonylureas, dipeptidyl peptidase-4 inhibitors, and basal insulin. Among patients with ≥2 fills for CANA, mean adherence (proportion of days covered) was slightly lower for H/L than non-H/L patients (0.77 vs. 0.80, p = 0.003). From their respective baseline A1C values, reduction in A1C was significantly greater for H/L than non-H/L patients (1.1% vs. 0.8%; p = 0.043).

Conclusion:

Compared with non-H/L patients, our H/L patients were younger and had higher mean baseline A1C. Significant improvement in glycemic control was observed for both cohorts, with greater improvement for H/L patients. Additional research is warranted, including longer follow-up and adjusting for possible confounding factors.

Keywords: :

• Canagliflozin
• Hemoglobin A1C
• Hispanic
• Latino
• Type 2 diabetes

Transparency

Declaration of funding

This study was supported by Janssen Scientific Affairs LLC.

Author contributions: Each author listed on this manuscript contributed work in accordance with ICMJE criteria for authorship: contributed to conception, design, and interpretation of data; contributed to the drafting and approved the final version of the manuscript; and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

H.J.H. and E.B. have disclosed that they are employees of Optum, a consulting firm retained by Janssen to conduct the study on which this manuscript is based. W.C. and M.F.T.R. have disclosed that they are employees of Janssen Scientific Affairs LLC, and own stock in the company. R.A. has disclosed that he provided scientific consulting services supported by Janssen.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgments

Caroline Jennermann (employee of Optum) provided medical writing assistance, supported by contract with Janssen Scientific Affairs LLC.