Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Alberta Strategy Patient Oriented Research Support Unit, Alberta Health Services, Calgary, Alberta, Canada.
Can J Diabetes. 2024 Jul;48(5):305-311.e1. doi: 10.1016/j.jcjd.2024.03.004. Epub 2024 Mar 27.
Since 2016, clinical guidelines have recommended sodium-glucose cotransporter-2 inhibitors (SGLT2is) for people with type 2 diabetes with heart failure. We examined SGLT2i dispensation, factors associated with dispensation, and heart failure hospitalization and all-cause mortality in people with diabetes and heart failure.
This retrospective, population-based cohort study identified people with diabetes and heart failure between January 1, 2014, and December 31, 2017, in Alberta, Canada, and followed them for a minimum of 3 years for SGLT2i dispensation and outcomes. Multivariate logistic regression assessed the factors associated with SGTL2i dispensation. Propensity scores were used with regression adjustment to estimate the effect of SGLT2i treatment on heart failure hospitalization.
Among 22,025 individuals with diabetes and heart failure (43.4% women, mean age 74.7±11.8 years), only 10.2% were dispensed an SGLT2i. Male sex, age <65 years, a higher baseline glycated hemoglobin, no chronic kidney disease, presence of atherosclerotic cardiovascular disease, and urban residence were associated with SGLT2i dispensation. Lower heart failure hospitalization rates were observed in those with SGLT2i dispensation (548.1 per 100 person-years) vs those without (813.5 per 1,000 person-years; p<0.001) and lower all-cause mortality in those with an SGLT2i than in those without (48.5 per 1,000 person-years vs 206.1 per 1,000 person-years; p<0.001). Regression adjustment found SGLT2i therapy was associated with a 23% reduction in hospitalization.
SGLT2is were dispensed to only 10% of people with diabetes and established heart failure, underscoring a significant care gap. SGLT2i use was associated with a real-world reduction in heart failure hospitalization and all-cause death. This study highlights an important opportunity to optimize SGLT2i use.
自 2016 年以来，临床指南推荐钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）用于有心力衰竭的 2 型糖尿病患者。我们研究了 SGLT2i 的处方情况、与处方相关的因素，以及有糖尿病和心力衰竭患者的心力衰竭住院和全因死亡率。
这项回顾性、基于人群的队列研究于 2014 年 1 月 1 日至 2017 年 12 月 31 日期间在加拿大艾伯塔省确定了有糖尿病和心力衰竭的患者，并对他们进行了至少 3 年的 SGLT2i 处方和结局随访。多变量逻辑回归评估了与 SGTL2i 处方相关的因素。使用倾向评分和回归调整来估计 SGLT2i 治疗对心力衰竭住院的影响。
在 22025 名有糖尿病和心力衰竭的患者（43.4%为女性，平均年龄 74.7±11.8 岁）中，只有 10.2%的患者处方了 SGLT2i。男性、年龄<65 岁、基线糖化血红蛋白较高、无慢性肾脏病、存在动脉粥样硬化性心血管疾病和居住在城市与 SGLT2i 处方相关。与未处方 SGLT2i 的患者相比，处方 SGLT2i 的患者心力衰竭住院率较低（548.1 例/100 人年），而全因死亡率较低（48.5 例/1000 人年）。回归调整发现 SGLT2i 治疗与住院率降低 23%相关。
SGLT2i 仅给 10%的有糖尿病和已确诊心力衰竭的患者处方，这突显了明显的治疗差距。SGLT2i 的使用与心力衰竭住院和全因死亡的真实世界降低相关。本研究强调了优化 SGLT2i 使用的重要机会。
