Manifestation of Heart Failure and Chronic Kidney Disease are Associated with Increased Mortality Risk in Early Stages of Type 2 Diabetes Mellitus: Analysis of a Japanese Real-World Hospital Claims Database

Kadowaki, Takashi; Komuro, Issei; Morita, Naru; Akiyama, Hiroki; Kidani, Yoko; Yajima, Toshitaka

doi:10.1007/s13300-021-01191-y

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…These validation results indicate the usefulness of our model as a support tool for a wide range of clinicians in the management of patients with T2DM. Patients with T2DM are at high risk for CKD and HF, and these complications have a significant impact on their prognosis 14,45 . However, there are not enough preventive measures nor early interventions implemented for CKD and HF in patients with T2DM, and one possible cause could be a difficulty in identifying patients at a high risk of these complications.…”

Section: Discussionmentioning

confidence: 99%

Machine learning models for prediction of HF and CKD development in early-stage type 2 diabetes patients

Kanda

Suzuki

Miyamoto

et al. 2022

Sci Rep

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Chronic kidney disease (CKD) and heart failure (HF) are the first and most frequent comorbidities associated with mortality risks in early-stage type 2 diabetes mellitus (T2DM). However, efficient screening and risk assessment strategies for identifying T2DM patients at high risk of developing CKD and/or HF (CKD/HF) remains to be established. This study aimed to generate a novel machine learning (ML) model to predict the risk of developing CKD/HF in early-stage T2DM patients. The models were derived from a retrospective cohort of 217,054 T2DM patients without a history of cardiovascular and renal diseases extracted from a Japanese claims database. Among algorithms used for the ML, extreme gradient boosting exhibited the best performance for CKD/HF diagnosis and hospitalization after internal validation and was further validated using another dataset including 16,822 patients. In the external validation, 5-years prediction area under the receiver operating characteristic curves for CKD/HF diagnosis and hospitalization were 0.718 and 0.837, respectively. In Kaplan–Meier curves analysis, patients predicted to be at high risk showed significant increase in CKD/HF diagnosis and hospitalization compared with those at low risk. Thus, the developed model predicted the risk of developing CKD/HF in T2DM patients with reasonable probability in the external validation cohort. Clinical approach identifying T2DM at high risk of developing CKD/HF using ML models may contribute to improved prognosis by promoting early diagnosis and intervention.

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Section: Discussionmentioning

confidence: 99%

Machine learning models for prediction of HF and CKD development in early-stage type 2 diabetes patients

Kanda

Suzuki

Miyamoto

et al. 2022

Sci Rep

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“…Although multifactorial interventions successfully reduce the risk of atherosclerotic cardiovascular diseases in patients with T2DM [ 51 , 52 ], the incidence of HF remains high even after controlling for risk factors, including blood pressure and lipids within their target ranges [ 53 ]. Furthermore, CKD and HF develop from the early stages of T2DM and place a substantial burden on the prognosis of T2DM [ 5 , 18 ], underscoring the need for early detection and early intervention. Recent real-world studies have demonstrated that the use of SGLT2i is associated with a slower decline in renal function [ 54 ] and lower incidence of cardiovascular events [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Japanese real-world data (RWD) have further provided evidence of the frequent manifestation of HF and CKD in the early stages of T2DM [ 5 , 17 , 18 ] and clinical benefits of SGLT2i in these patients [ 19 , 20 ]. Unlike the ADA and EASD guidelines, the Japanese clinical practice guidelines do not recommend specific pharmacotherapies for T2DM, and instead endorse the selection of drugs on the basis of the patient’s disease condition.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Initiating Type 2 Diabetes Therapy with a Sodium–Glucose Cotransporter 2 Inhibitor Versus Conventional Therapy in Japan

et al. 2022

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Introduction Many patients with type 2 diabetes mellitus (T2DM) suffer from complications that impose substantial burdens on prognosis and medical costs. Accumulating evidence has demonstrated the clinical benefit of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular and renal complications. However, the health economic impact of SGLT2i remains unclear. The aim of this study was to evaluate the cost-effectiveness of initiating antidiabetic therapy with an SGLT2i using Japanese real-world data. Methods We constructed a natural history model incorporating heart failure (HF), myocardial infarction, stroke, chronic kidney disease, and end-stage renal disease (ESRD) as complications. The target population comprised patients with T2DM who newly initiated their first oral glucose-lowering drugs. By using a population-based microsimulation, we estimated the 10-year medical costs in Japanese yen (JPY) and outcomes (hospitalization for/development of complications and quality-adjusted life years [QALY]) for patients who initiated antidiabetic therapy with an SGLT2i or conventional therapy. Sensitivity analyses included a probabilistic sensitivity analysis (PSA) with 1,000,000 iterations. Results In the base-case analysis, the total medical cost per person was JPY 1,638,806 versus JPY 1,825,033 and the QALYs were 8.732 versus 8.513 for the SGLT2i strategy versus the conventional strategy, respectively. Thus, initiating treatment with an SGLT2i was dominant, more effective (QALY gain), and lower cost. When treating 10,000 patients, the SGLT2i strategy would reduce all-cause deaths by 410 (552 vs 962), HF events by 201 (897 vs 1098), and ESRD events by 16 (16 vs 32) versus the conventional strategy. The PSA revealed that the probability of dominance for initiating SGLT2i therapy was 90.5%, demonstrating the robustness of the results. Conclusion Our results suggest that initiating T2DM treatment with SGLT2i, aimed at managing cardiovascular and renal complications from the early stages of diabetes, can improve the clinical outcome and reduce cost burden of T2DM.

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“…It is well known that patients with diabetes frequently develop micro- and macrovascular complications, which worsen the prognosis and quality of life (QOL) of patients. More recently, a multinational cohort study demonstrated that HF and CKD are early and frequent complications in patients with T2DM ( 10 ), and their risk of developing these complications is double that of individuals without T2DM ( 11 ). For managing diabetic complications, glucose-lowering drugs are of great importance, together with diet and exercise therapy.…”

Section: Sglt2i For the Prevention Of Diabetic Complicationsmentioning

confidence: 99%

“…Moreover, decreased renal function is associated with an increased risk of the onset of HF and CV death ( 7 – 10 ). In fact, the prognosis of patients with concomitant T2DM, HF, and CKD is extremely poor ( 11 ). Given the vicious interactions among these disorders, holistic interventions that can simultaneously target the multiple disorders in CRM syndrome are of great importance ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Evolution of sodium-glucose co-transporter 2 inhibitors from a glucose-lowering drug to a pivotal therapeutic agent for cardio-renal-metabolic syndrome

et al. 2023

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Cardio-renal-metabolic (CRM) syndrome, which involves type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF), is a serious healthcare issue globally, with high morbidity and mortality. The disorders that comprise CRM syndrome are independent can mutually affect and accelerate the exacerbation of each other, thereby substantially increasing the risk of mortality and impairing quality of life. To manage CRM syndrome by preventing vicious interactions among individual disorders, a holistic treatment approach that can simultaneously address multiple disorders underpinning CRM syndrome is of great importance. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) lower blood glucose levels by inhibiting glucose reabsorption in the renal proximal tubule and were first indicated for the treatment of T2DM. Several cardiovascular outcome trials have demonstrated that SGLT2i not only lower blood glucose but also reduce the risk of hospitalization for HF and worsening renal function in patients with T2DM. Results have also suggested that the observed cardiorenal benefits of SGLT2i may be independent of their blood glucose-lowering effects. Several randomized controlled trials subsequently assessed the efficacy and safety of SGLT2i in patients without T2DM, and revealed considerable benefits of SGLT2i treatment against HF and CKD, regardless of the presence of T2DM. Thus, SGLT2i have become an essential therapeutic option to prevent the onset, slow the progression, and improve the prognosis of CRM syndrome. This review assesses the evolution of SGLT2i from a glucose-lowering drug to a therapeutic agent for CRM syndrome by evaluating epoch-making clinical studies, including randomized control trials and real-world studies.

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Manifestation of Heart Failure and Chronic Kidney Disease are Associated with Increased Mortality Risk in Early Stages of Type 2 Diabetes Mellitus: Analysis of a Japanese Real-World Hospital Claims Database

Cited by 10 publications

References 29 publications

Machine learning models for prediction of HF and CKD development in early-stage type 2 diabetes patients

Machine learning models for prediction of HF and CKD development in early-stage type 2 diabetes patients

Cost-Effectiveness Analysis of Initiating Type 2 Diabetes Therapy with a Sodium–Glucose Cotransporter 2 Inhibitor Versus Conventional Therapy in Japan

Evolution of sodium-glucose co-transporter 2 inhibitors from a glucose-lowering drug to a pivotal therapeutic agent for cardio-renal-metabolic syndrome

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