Health care provider experience with canagliflozin in real-world clinical practice: favorability, treatment patterns, and patient outcomes

Figures & data

Table 1 Characteristics of providers and practices

Measures	Provider type								One-way ANOVA p-value
	Endocrinologist (N=101)		PCP (N=101)		NP/PA (N = 100)		Total (N= 302)
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Years in practice	16.30^a	7.89	19.53^b	6.87	13.72^c	7.04	16.53	7.64	<0.001
	N	%	N	%	N	%	N	%	Chi-square p-value or Fisher’s exact test*
Provider gender
Female	19^a	18.8	22^a	21.8	74^b	74.0	115	38.1	<0.001
Provider age (years)
<45	36^a	35.6	22^b	21.8	50^c	50.0	108	35.8	<0.001*
45–64	54^a	53.5	71^b	70.3	48^a	48.0	173	57.3
>65	7^a	6.9	5^a,b	5.0	1^b	1.0	13	4.3
Decline to answer	4^a	4.0	3^a	3.0	1^a	1.0	8	2.6
Provider private practice setting
Private solo practice	22^a,b	21.8	30^a	29.7	15^b	15.0	67	22.2	<0.001*
Private group practice	57^a	56.4	61^a	60.4	55^a	55.0	173	57.3
Health system	16^a	15.8	8^a	7.9	13^a	13.0	37	12.3
Other (e.g., stand-alone hospital, community center, or diabetes center)	6^a	5.9	2^a	2.0	17^b	17.0	25	8.3

Notes:

* Test of independence conducted using Fisher’s exact test when counts are <5. For pairwise comparisons, refer to superscripts (e.g., a, b, c) attached to column percentages. Column percentages in the same row that do not share the same superscripts (e.g., XX^a vs XX^b) are significantly different at p<0.05. If the values share the same superscripts (e.g., XX^a vs XX^a or XX^a,b vs XX^a) then they are not significantly different at p<0.05.

Abbreviations: ANOVA, analysis of variance; PCP, primary care physician; NP/PA, nurse practitioners/physician assistants.

Table 2 Canagliflozin/canagliflozin-metformin compared to DPP-4 inhibitor attributes for the treatment of T2DM by provider type

Measures	Canagliflozin/canagliflozin-metformin compared to DPP-4s							Canagliflozin/canagliflozin-metformin compared to SUs
	Provider type						Chi-square p-value	Provider type						Chi-square p-value or Fisher’s exact test*
	Endocrinologist (N=101)		PCP (N=101)		NP/PA (N=100)			Endocrinologist (N=100)		PCP (N=101)		NP/PA (N=101)
	N	%	N	%	N	%		N	%	N	%	N	%
Effect on HbA1c
More favorable	45^a	44.6	26^b	25.7	38^a,b	38.0	0.089	41	40.6	47	46.5	49	49.0	0.106*
Equally favorable	39^a	38.6	46^a	45.5	45^a	45.0		34	33.7	24	23.8	36	36.0
Less favorable	12^a	11.9	23^b	22.8	12^a	12.0		23	22.8	24	23.8	11	11.0
Do not know	5^a	5.0	6^a	5.9	5^a	5.0		3	3.0	6	5.9	4	4.0
Effect on blood pressure
More favorable	64^a	63.4	40^b	39.6	49^b	49.0	0.029	82^a	81.2	64^b	63.4	56^b	56.0	0.001*
Equally favorable	26^a	25.7	37^a	36.6	31^a	31.0		11^a	10.9	28^b	27.7	24^b	24.0
Less favorable	6^a	5.9	16^b	15.8	10^a,b	10.0		6^a	5.9	5^a	5.0	9^a	9.0
Do not know	5^a	5.0	8^a	7.9	10^a	10.0		2^a	2.0	4^a,b	4.0	11^b	11.0
Effect on body weight
More favorable	62^a	61.4	44^b	43.6	52^a,b	52.0	0.065	79	78.2	70	69.3	72	72.0	0.653*
Equally favorable	22^a	21.8	35^b	34.7	34^a,b	34.0		11	10.9	18	17.8	17	17.0
Less favorable	10^a,b	9.9	15^a	14.9	5^b	5.0		8	7.9	11	10.9	7	7.0
Do not know	7^a	6.9	7^a	6.9	9^a	9.0		3	3.0	2	2.0	4	4.0
Out-of-pocket cost for patient
More favorable	20	19.8	18	17.8	30	30.0	0.339	28	27.7	16	15.8	19	19.0	0.164*
Equally favorable	39	38.6	40	39.6	39	39.0		11	10.9	21	20.8	19	19.0
Less favorable	29	28.7	26	25.7	19	19.0		59	58.4	57	56.4	55	55.0
Do not know	13	12.9	17	16.8	12	12.0		3	3.0	7	6.9	7	7.0
Risk of hypoglycemia
More favorable	12^a	11.9	18^a,b	17.8	23^b	23.0	0.064	76	75.2	63	62.4	63	63.0	0.231*
Equally favorable	70^a	69.3	56^b	55.4	46^b	46.0		12	11.9	19	18.8	24	24.0
Less favorable	14^a	13.9	18^a	17.8	23^a	23.0		8	7.9	14	13.9	10	10.0
Do not know	5^a	5.0	9^a	8.9	8^a	8.0		5	5.0	5	5.0	3	3.0
Patient satisfaction
More favorable	24	23.8	17	16.8	23	23.0	0.550	49	48.5	43	42.6	49	49.0	0.315
Equally favorable	44	43.6	52	51.5	53	53.0		31	30.7	40	39.6	40	40.0
Less favorable	25	24.8	21	20.8	16	16.0		11	10.9	13	12.9	6	6.0
Do not know	8	7.9	11	10.9	8	8.0		10	9.9	5	5.0	5	5.0

Notes:

* Test of independence conducted using Fisher’s exact test when counts are <5. For pairwise comparisons, refer to superscripts (e.g., a, b, c) attached to column percentages. Column percentages in the same row that do not share the same superscripts (e.g., XX^a vs XX^b) are significantly different at p<0.05. If the values share the same superscripts (e.g., XX^a vs XX^a or XX^a,b vs XX^a) then they are not significantly different at p<0.05.

Abbreviations: PCP, primary care physician; NP/PA, nurse practitioners/physician assistants; T2DM, type 2 diabetes mellitus; DPP4, dipeptidyl peptidase-4; SU, sulfonylureas; HbA1c, glycosylated hemoglobin.

Table 3 Confidence in canagliflozin/canagliflozin-metformin for each line of therapy

Line of Therapy	Provider type								Chi-square p-value or Fisher’s exact test*
	Endocrinologist (N=101)		PCP (N=101)		NP/PA (N=100)		Total (N=302)
	N	%	N	%	N	%	N	%
First line
Not at all confident	24^a	23.8	20^a,b	19.8	13^b	13.0	57	18.9	0.003
Slightly confident	18^a	17.8	19^a	18.8	33^b	33.0	70	23.2
Moderately confident	15^a	14.9	19^a,b	18.8	28^b	28.0	62	20.5
Very confident	34^a	33.7	25^a,b	24.8	17^b	17.0	76	25.2
Extremely confident	10^a	9.9	18^a	17.8	9^a	9.0	37	12.3
Second line
Not at all confident	3^a	3.0	4^a	4.0	4^a	4.0	11	3.6	0.772*
Slightly confident	14^a	13.9	11^a	10.9	9^a	9.0	34	11.3
Moderately confident	24^a	23.8	30^a	29.7	31^a	31.0	85	28.1
Very confident	42^a	41.6	32^a	31.7	38^a	38.0	112	37.1
Extremely confident	18^a	17.8	24^a	23.8	18^a	18.0	60	19.9
Third line
Not at all confident	1^a	1.0	1^a	1.0	0	0.0	2	0.7	0.149*
Slightly confident	4^a	4.0	8^a	7.9	4^a	4.0	16	5.3
Moderately confident	35^a	34.7	18^b	17.8	22^b	22.0	75	24.8
Very confident	42^a	41.6	47^a	46.5	50^a	50.0	139	46.0
Extremely confident	19^a	18.8	27^a	26.7	24^a	24.0	70	23.2
Fourth line
Not at all confident	3^a	3.0	3^a	3.0	1^a	1.0	7	2.3	0.409*
Slightly confident	9^a	8.9	5^a	5.0	10^a	10.0	24	7.9
Moderately confident	29^a	28.7	22^a,b	21.8	17^b	17.0	68	22.5
Very confident	40^a	39.6	44^a	43.6	43^a	43.0	127	42.1
Extremely confident	20^a	19.8	27^a	26.7	29^a	29.0	76	25.2

Notes:

* Test of independence conducted using Fisher’s exact test when counts are <5. For pairwise comparisons, refer to superscripts (e.g., a, b, c) attached to column percentages. Column percentages in the same row that do not share the same superscripts (e.g., XX^a vs XX^b) are significantly different at p<0.05. If the values share the same superscripts (e.g., XX^a vs XX^a or XX^a,b vs XX^a) then they are not significantly different at p<0.05.

Abbreviations: PCP, primary care physician; NP/PA, nurse practitioners/physician assistants.

Table 4 Prescribing by provider type for each line of therapy

Line of therapy	Provider type
	Endocrinologist (N=101)		PCP (N=101)		NP/PA (N=100)
	Mean	SD	Mean	SD	Mean	SD
First line
SGLT2 inhibitors alone or in FDC with metformin	5.04 41.47	7.61 23.1	5.8 41.72	7.21 22.2	5.6 46.03	7.96 21.1
Second line
SGLT2 inhibitors alone or in FDC with metformin	12.61 43.11	10.89 23.18	11.48 45.89	8.19 21.82	12.01 49.39	10.52 24.86
Third line
SGLT2 inhibitors alone or in FDC with metformin	15.68 45.34	13.96 24.14	13.76 44.82	11.22 22.38	12.73 51.74	10.32 24.52
Fourth line
SGLT2 inhibitors alone or in FDC with metformin	12.03 42.6	10.66 25.65	10.63 42.33	10.95 20.25	11.25 46.45	12.17 23.63

Notes: Sample sizes for those who prescribed SLGT2 inhibitors for first line: endocrinologist (n=62), PCP (n=65), NP/PA (n=59); line 2: endocrinologist (n=88), PCP (n=87), NP/PA (n=85); line 3: endocrinologist (n=90), PCP (n=87), NP/PA (n=86); line 4: endocrinologist (n=83), PCP (n=73), NP/PA (n=69). There were no statistically significant differences across provider type.

Abbreviations: PCP, primary care physician; NP/PA, nurse practitioners/physician assistants; FDC, fixed-dose combination.

Table 5 Canagliflozin/canagliflozin-metformin prescribing

		Provider type			Chi-square p-value or Fisher’s exact test*
		Endocrinologist (N=101), %	PCP (N=101), %	NP/PA (N=100), %
Characteristics ranked as top 3 that make a patient a good candidate
	Good kidney function	36.6	29.7	42.0	0.191
	Good liver function	3.0	4.0	9.0	0.120*
	No history of UTI	19.8	9.9	13.0	0.120
	No history of GMI	10.9	7.9	10.0	0.763
	Overweight or have weight concerns	47.5	48.5	47.0	0.976
	Blood pressure	13.9	12.9	10.0	0.687
	History of hypoglycemia	19.8	24.8	16.0	0.301
	Been on other T2DM treatments for a long time	18.8	16.8	13.0	0.525
	Do not want an injectable/trying to delay injectables as long as possible	36.6	35.6	38.0	0.941
	Insurance coverage/affordability for long-term use	38.6	44.6	42.0	0.692
	Willing to take a medication that is “new” to market	7.9	11.9	10.0	0.642
	Willing to accept or put up with frequent urination	12.9^a	22.8^a	13.0^a	0.091
	Overall treatment safety	31.7	29.7	37.0	0.523
	Other	2.0	1.0	0.0	1.000*
The treatment discussion and treatment decision maker
Provider makes the final treatment decision	Never	2^a	2^a	0.0	0.010*
	Rarely/sometimes	12.9^a	12.9^a	28.3^b
	Often/always	85.1 ^a	85.1^a	71.7^b
Provider discusses treatment and then makes recommendation	Never	1.0	2.0	1.0	0.897*
	Rarely/sometimes	9.9	6.9	7.1
	Often/always	89.1	91.1	91.9
Provider discusses treatment and patient makes decision	Never	3.0	2.0	1.0	0.950*
	Rarely/sometimes	50.5	49.5	51.5
	Often/always	46.5	48.5	47.5
Attributes of canagliflozin/canagliflozin-metformin typically discussed when discussing as a treatment option
Attributes typically discussed	Mechanism of action	67.7	59.0	65.0	0.426
	Copay cards offered by manufacturer	49.5^a,b	40^a	60^b	0.018
	Dosing and administration	59.6^a	53^a	73^b	0.012
	Urge/need for frequent urination	54.5^a	37^b	55^a	0.015
	Out-of-pocket cost	41.4	49.0	56.0	0.120
	Insurance coverage	47.5	54.0	59.0	0.263
	Concomitant medication use	29.3	26.0	39.0	0.120
	HbA1c reduction	75.8	81.0	79.0	0.661
	Impact on weight	81.8^a	63^b	77^a	0.007
	Lowering of systolic blood pressure	58.6^a	44^b	44^b	0.060
	Potential rise in low-density lipoprotein (LDL) cholesterol	26.3	16.0	24.0	0.185
	UTI and/or GMI	77.8^a	59.0^b	67.0^a,b	0.017
	Risk of hypoglycemia	54.5^a	36.0^b	57.0^a	0.005
	Overall treatment safety	47.5^a,b	38.0^a	56.0^b	0.039
	Other	3.0	1.0 3.0		0.641*

Note:

* Test of independence conducted using Fisher’s exact test when counts are <5. For pairwise comparisons, refer to superscripts (e.g., a, b, c) attached to column percentages. Column percentages in the same row that do not share the same superscripts (e.g., XX^a vs XX^b) are significantly different at p<0.05. If the values share the same superscripts (e.g., XX^a vs XX^a or XX^a,b vs XX^a) then they are not significantly different at p<0.05. Only includes respondents who indicated that canagliflozin/canagliflozin-metformin was included in treatment discussion: endocrinologist (n=99), PCP (n=100), NP/PA (n=100).

Abbreviations: PCP, primary care physician; NP/PA, nurse practitioners/physician assistants; UTI, urinary tract infection; GMI, genital mycotic infection; T2DM, type 2 diabetes mellitus; HbA1c, glycosylated hemoglobin.

Table 6 Positive changes observed by provider type (categorical) when managing patients with T2DM on canagliflozin/canagliflozin-metformin

Outcomes	Provider type
	Endocrinologist (N=101), %	PCP (N=101), %	NP/PA (N=100), %
Lowering/controlling HbA1c
Never	0.0	0.0	1.0
Rarely	1.0	0.0	0.0
Sometimes	14.9	17.8	11.0
Often/always	84.2	82.2	88.0
Lowering/controlling blood pressure
Rarely	7.9	6.9	6.0
Sometimes	43.6	45.5	43.0
Often/always	48.5	47.5	51.0
Weight loss
Never	0.0	0.0	1.0
Rarely	4.0	6.9	3.0
Sometimes	27.7	33.7	43.0
Often/always	68.3	59.4	53.0
Improvement in overall quality of life
Never	1.0	0.0	0.0
Rarely	6.9	7.9	5.0
Sometimes	39.6	41.6	45.0
Often/always	52.5	50.5	50.0
Feeling emotionally better that their T2DM is being managed well
Never	0.0	1.0	0.0
Rarely	5.0	6.9	6.0
Sometimes	46.5	34.7	33.0
Often/always	48.5	57.4	61.0
Behaving positively by adhering to treatment and/or follow-up visits
Never	1.0	1.0	0.0
Rarely	5.9	5.0	4.0
Sometimes	38.6	37.6	33.0
Often/always	54.5	56.4	63.0
Behaving positively by making changes to diet and exercise
Never	1.0	0.0	0.0
Rarely	9.9	9.9	9.0
Sometimes	39.6	41.6	43.0
Often/always	49.5	48.5	48.0
Having a hopeful outlook for managing T2DM
Never	1.0	0.0	0.0
Rarely	3.0	2.0	6.0
Sometimes	41.6	40.6	37.0
Often/always	54.5	57.4	57.0

Note: There were no statistically significant differences across provider type.

Abbreviations: PCP, primary care physician; NP/PA, nurse practitioners/physician assistants; T2DM, type 2 diabetes mellitus; HbA1c, glycosylated hemoglobin.

Table S1 Patient characteristics by provider type

Patient characteristics	Provider type						One-way ANOVA p-value
	Endocrinologist (N=101)		PCP (N=101)		NP/PA (N=100)
	Mean	SD	Mean	SD	Mean	SD
Age (% of patients, years)
<18	2.46^a	4.27	2.98^a	5.29	3.00^a	4.38	0.644
18–44	21.83^a,b	9.29	20.03^a	12.2	23.60^b	11.03	0.069
45–64	35.62^a	11.89	35.93^a	13.84	37.19^a	12.28	0.652
65–74	25.01^a	8.94	26.30^a	12.75	24.81^a	13.3	0.625
≥75	15.08^a	8.13	14.76^a	11.04	11.40^b	11.54	0.021
Ethnicity (% of patients)
White	60.41^a	21.32	59.72^a	26.83	46.80^b	23.08	<0.001
Black or African American	16.93^a	11.81	17.61^a	14.82	24.17^b	16.73	0.001
Hispanic or Latino	12.89^a	10.45	13.75^a	15.35	18.79^b	15.81	0.006
Asian	7.01^a	7.72	6.96^a	11.38	5.91^a	5.93	0.597
Other (mixed racial background, native American, etc.)	2.76^a,b	5.3	1.95^a	4.69	4.33^b	11.03	0.078
Insurance (% of patients)
Commercial	56.16^a	18.43	52.34^a	19.13	43.61^b	20.2	<0.001
Medicaid	10.10^a	10.38	11.28^a	11.15	19.17^b	18.29	<0.001
Medicare	29.92^a	13.69	29.76^a	15.77	32.76^a	14.18	0.262
Uninsured	3.65^a	4.4	6.93^b	8.96	6.78^b	6.82	0.001
Other	1.36^a	10.09	0.11^a	0.65	0.78^a	6.57	0.445
HbA1c level (% of patients)
<7.0	34.80^a	20.53	41.33^b	21.57	30.97^a	19.45	0.002
7.0–7.9	28.06^a	11.57	29.82^a,b	12.63	31.60^b	12.71	0.127
8.0–9.0	22.15^a	12.37	18.04^b	11	23.06^a	11.24	0.005
>9.0	14.99^a	8.92	10.81^b	8.01	14.37^a	9.11	0.001
	N	%	N	%	N	%	Chi-square p-value
Patient’s education level
High School or less	35^a	34.70	37^a,b	36.60	49^b	49.00	0.083
College or more	41^a	40.60	40^a	39.60	24^b	24.00
Do not know	25^a	24.80	24^a	23.80	27^a	27.00

Notes: For pairwise comparisons, refer to superscripts (e.g., a, b, c) attached to column means. Column means in the same row that do not share the same superscripts (e.g., XX^a vs XX^b) are significantly different at p<0.05. If the values share the same superscripts (e.g., XX^a vs XX^a or XX^a,b vs XX^a) then they are not significantly different at p<0.05.

Abbreviations: PCP, primary care physician; NP/PA, nurse practitioners/physician assistants; ANOVA, analysis of variance; HbA1c, glycosylated hemoglobin.