Generalizability and treatment with sodium-glucose co-trasporter-2 inhibitors (SGLT2i) among patients with type 2 diabetes: an assessment using an Italian primary care database.

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Acta Diabetologica Pub Date : 2024-08-29 DOI:10.1007/s00592-024-02359-1

Ippazio Cosimo Antonazzo, Davide Rozza, Paolo Angelo Cortesi, Carla Fornari, Elena Zanzottera Ferrari, Claire Paris, Caroline Eteve-Pitsaer, Marco Gnesi, Silvia Mele, Marco D'Amelio, Anna Rita Maurizi, Pasquale Palladino, Lorenzo Giovanni Mantovani, Giampiero Mazzaglia

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Abstract

Aims: This study aimed to assess the proportions of type 2 diabetes (T2D) subjects meeting cardiovascular outcome trials (CVOTs) criteria for sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and estimate SGLT2i utilization, along with associated demographic and clinical characteristics, in a primary care setting.

Methods: T2D patients in Italy were selected between January 1, 2021, and December 31, 2022, from The Health Improvement Network (THIN^®) database. Representativeness was determined by dividing patients meeting key inclusion criteria for four CVOTs (CANVAS, DECLARE-TIMI 58, EMPA-REG OUTCOME, VERTIS-CV) to the total T2D population. Demographic and clinical characteristics of eligible T2D subjects and SGLT2i users were compared, and logistic regression models assessed the likelihood of receiving SGLT2i.

Results: Out of 17,102 T2D patients, 8,828 met eligibility criteria for at least one CVOT. DECLARE-TIMI 58 exhibited the highest representativeness (51.1%), compared to CANVAS (21.1%), EMPA-REG OUTCOME (5.5%), and VERTIS-CV (4.9%) trials. Eligible CVOTs patients were older (74.6 vs. 68.3 years), with a longer disease duration (10.2 vs. 9.7 years), and higher established cardiovascular disease (CVD) prevalence (36.0 vs. 27.3%) compared to SGLT2i users. Less than 10% of eligible T2D patients received SGLT2i. Males (OR: 1.43; 95%CI: 1.24-1.66) were more likely to be prescribed SGLT2i than other antidiabetic drugs, while the elderly (80 + vs. 40-64 years, OR: 0.17; 95% CI: 0.14-0.22) were less likely. Eligible T2D patients with CVD reported an increased likelihood of receiving SGLT2is compared to other antidiabetics.

Conclusion: This study highlights significant variability in the proportion of T2D subjects meeting SGLT2i CVOT inclusion criteria, with DECLARE-TIMI-58 being the most represented. Low SGLT2i prescription rates in the Italian primary care setting, along with substantial demographic and clinical differences between SGLT-2i users and T2D eligible patients, emphasize the need for targeted interventions to optimize the use of these medications in primary care settings.

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2 型糖尿病患者使用钠-葡萄糖共转运体-2 抑制剂 (SGLT2i) 的普遍性和治疗：使用意大利初级保健数据库进行的评估。

目的：本研究旨在评估符合钠-葡萄糖共转运体-2 抑制剂（SGLT-2i）心血管结局试验（CVOT）标准的 2 型糖尿病（T2D）患者的比例，并估算 SGLT2i 的使用情况以及相关的人口统计学和临床特征：从健康改善网络 (THIN®) 数据库中选取了 2021 年 1 月 1 日至 2022 年 12 月 31 日期间的意大利 T2D 患者。将符合四项 CVOT（CANVAS、DECLARE-TIMI 58、EMPA-REG OUTCOME、VERTIS-CV）关键纳入标准的患者与 T2D 患者总数进行比较，确定其代表性。比较了符合条件的 T2D 受试者和 SGLT2i 使用者的人口统计学和临床特征，并通过逻辑回归模型评估了接受 SGLT2i 治疗的可能性：在 17102 名 T2D 患者中，有 8828 人符合至少一项 CVOT 的资格标准。DECLARE-TIMI 58试验的代表性最高（51.1%），相比之下，CANVAS（21.1%）、EMPA-REG OUTCOME（5.5%）和VERTIS-CV（4.9%）试验的代表性较低。与 SGLT2i 用户相比，符合条件的 CVOTs 患者年龄更大（74.6 岁对 68.3 岁），病程更长（10.2 年对 9.7 年），心血管疾病（CVD）发病率更高（36.0% 对 27.3%）。在符合条件的 T2D 患者中，接受 SGLT2i 治疗的不到 10%。与其他抗糖尿病药物相比，男性（OR：1.43；95%CI：1.24-1.66）更有可能被处方 SGLT2i，而老年人（80 岁以上 vs. 40-64 岁，OR：0.17；95%CI：0.14-0.22）更不可能被处方 SGLT2i。与其他抗糖尿病药物相比，患有心血管疾病的合格 T2D 患者接受 SGLT2is 治疗的可能性更大：本研究显示，符合 SGLT2i CVOT 纳入标准的 T2D 受试者比例存在显著差异，其中 DECLARE-TIMI-58 的比例最高。在意大利初级医疗机构中，SGLT2i 的处方率较低，SGLT2i 使用者与符合条件的 T2D 患者在人口统计学和临床方面存在很大差异，这突出表明需要采取有针对性的干预措施，以优化这些药物在初级医疗机构中的使用。

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来源期刊

Acta Diabetologica 医学-内分泌学与代谢

CiteScore

7.30

自引率

2.60%

发文量

180

审稿时长

2 months

期刊介绍： Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.