Data Scientist Odysseus Data Services Inc. Richmond, United States
Background: Chronic kidney disease (CKD) is a complication of type 2 diabetes (T2D). Appropriate glycemic control can help delay progression. There are several anti-hyperglycemic treatments available, however, there is no consensus treatment for patients with T2D and CKD.
Objectives: to describe clinical characteristics and treatment patterns of patients with T2D and CKD who initiate one of 6 anti-hyperglycemic agents (AHA) (SGLT2, GLP1, DPP4, metformin, sulfonylureas and insulin).
Methods: Data from the UK (CPRD GOLD and AURUM) and US (Optum Claims, Optum EHR, and Truven MarketScan) standardized to the OMOP CDM were used to identify patients with T2D and CKD patients who were new users of one of the 6 AHA. The study timeframe spanned from 2010 to 2021. Combination therapies were defined as any treatment occurring within 30 days of the index drug. Discontinuation was defined as at least a 90 day gap between two consecutive claims/prescription dates during the follow-up, or initiation of an alternative AHA from a different class or death. Discontinuation of initial AHA and initiation of an alternative agent from a different class on or at least 30 days before or after discontinuation of the index therapy was considered a switch. Characteristics of patients and treatment patterns were described.
Results: A total of 3.3m patients with T2D and CKD initiating one of the 6 AHAs (0.2m SGLT2, 0.3m GLP1-RA, 0.4m DPP4, 0.5m metformin, 1.3m sulfonylureas and 0.7m insulin) were included from 5 databases. The median age ranged from 57 years old in the GLP1 cohort in MarketScan to 74 in DPP4 cohort in AURUM. Proportion of female was similar across cohorts except SGLT2 (female range of 38-44%). The most prescribed index AHA were sulfonylureas (1m) in Optum claims, insulin (0.5m) in Optum EHR, metformin (0.6m) in MarketScan, DPP4 (0.05m) in AURUM, and DPP4 (0.2m) in GOLD. Comorbidities were similar across the 6 cohorts, however, in the US databases hypertension was more prevalent (ranging from 80-90%). The most common treatment pattern was monotherapy with the index AHA: DPP4 (39k) in AURUM, DPP4 (12k) in GOLD, insulin (48k) in MarketScan, metformin (99k) in Optum claims and insulin (356k) in Optum EHR. Treatment switches were common among metformin and sulfonylureas and less among SGLT2 and GLP1 cohorts. SGLT2 had the longest median time to discontinuation (range of 2.3-2.5 years) in the UK and metformin was longest (range of 1.7-2.9) in the US. Insulin had the lowest median time to discontinuation (range of 1.1-1.7).
Conclusions: Glucose control therapy for patients with CKD and T2D is heterogenous. Using a network of large-scale observational data, we observed small differences in the patient profiles between old and novel T2D therapies.
