Chow Wing, Buysman Erin, Rupnow Marcia F T, Aguilar Richard, Henk Henry J
a a Health Economics & Outcomes Research, Janssen Scientific Affairs LLC , Raritan , NJ , USA.
b b Health Economics and Outcomes Research , Optum, Eden Prairie, MN , USA.
Curr Med Res Opin. 2016;32(1):13-22. doi: 10.1185/03007995.2015.1100598. Epub 2015 Oct 27.
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).
To describe characteristics and compare glycemic control between H/L and non-H/L patients with T2DM filling their first prescription for CANA.
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.
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).
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.
西班牙裔/拉丁裔（H/L）族群与2型糖尿病（T2DM）的较高患病率以及更多并发症和合并症相关。很少有关于降糖药物（AHA）的研究比较过H/L患者与非H/L患者。随机对照试验和观察性研究表明，卡格列净（CANA）在降低糖化血红蛋白（A1C）方面有效。
描述首次开具CANA处方的T2DM患者中H/L与非H/L患者的特征，并比较其血糖控制情况。
这项回顾性队列研究检查了2013年4月1日至2013年10月31日期间开具≥1张CANA处方的糖尿病患者的医疗保健理赔数据。我们收集了可用的人口统计学数据；种族按照先前发表的方法进行推算。临床数据包括糖尿病并发症严重程度指数（DCSI）、A1C值以及任何AHA的理赔情况，并进行了6个月的随访。
我们的样本包括438名（11.4%）H/L个体和3408名（88.6%）非H/L个体；每个队列中女性占43%。与非H/L患者相比，H/L患者更年轻（53岁对56岁，p<0.001），平均基线A1C更高（分别为8.9%对8.5%；p=0.028）。队列之间的平均DCSI相似（H/L为0.92，非H/L为0.84，p=0.289）。更多H/L患者（25%）在首次开具CANA处方时正在服用≥3种AHA（非H/L患者为21%；p=0.044），最常见的是二甲双胍，其次是磺脲类药物、二肽基肽酶-4抑制剂和基础胰岛素。在开具≥2张CANA处方的患者中，H/L患者的平均依从性（覆盖天数比例）略低于非H/L患者（0.77对0.80，p=0.003）。从各自的基线A1C值来看，H/L患者的A1C降低幅度显著大于非H/L患者（1.1%对0.8%；p=0.043）。
与非H/L患者相比，我们研究中的H/L患者更年轻，平均基线A1C更高。两个队列的血糖控制均有显著改善，H/L患者的改善更大。有必要进行更多研究，包括更长时间的随访以及对可能的混杂因素进行调整。
