Nordic Longitudinal Data from Electronic Medical Records and Full Population National Registers: Unique Opportunities for New Insights in Benefit of Diabetes Patients

Diabetes Obesity Metabolism

Nyström

et al. 2019

Aims To investigate cardiovascular (CV) safety and event rates for dapagliflozin versus other glucose‐lowering drugs (GLDs) in a real‐world type 2 diabetes population after applying the main inclusion criteria and outcomes from the DECLARE‐TIMI 58 study. Methods Patients with new initiation of dapagliflozin and/or other GLDs were identified in Swedish nationwide healthcare registries for the period 2013 to 2016. Patients were included if they met the main DECLARE‐TIMI 58 inclusion criteria: age ≥40 years and established CV disease or presence of multiple‐risk factors, e.g. men aged ≥55 years and women aged ≥60 years with hypertension or dyslipidaemia. Propensity scores for the likelihood of dapagliflozin initiation were calculated, then 1:3 matching was carried out. DECLARE‐TIMI 58 outcomes were hospitalization for heart failure (HHF) or CV‐specific mortality, and major adverse CV events (MACE; CV‐specific mortality, myocardial infarction, or stroke). Cox survival models were used to estimate hazard ratios (HRs). Results After matching, a total of 28 408 new‐users of dapagliflozin and/or other GLDs were identified, forming the population for the present study (henceforth referred to as the DECLARE‐like cohort. The mean age of this cohort was 66 years, and 34% had established CV disease. Dapagliflozin was associated with 21% lower risk of HHF or CV mortality versus other GLDs (HR 0.79, 95% confidence interval [CI] 0.69‐0.92) and had no significant association with MACE (HR 0.90, 95% CI 0.79‐1.03). HHF and CV mortality risks, separately, were lower at HR 0.79 (95% CI 0.67‐0.93) and HR 0.75 (95% CI 0.57‐0.97), respectively. Non‐significant associations were seen for myocardial infarction and stroke: HR 0.91 (95% CI 0.74‐1.11) and HR 1.06 (95% CI 0.87‐1.30), respectively. Conclusion In a real‐world population similar to those included in the DECLARE‐TIMI 58 study, dapagliflozin was safe with regard to CV outcomes and resulted in lower event rates of HHF and CV mortality versus other GLDs.

Section: Methodsmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

Dapagliflozin and cardiovascular mortality and disease outcomes in a population with type 2 diabetes similar to that of the DECLARE‐TIMI 58 trial: A nationwide observational study

Norhammar

Diabetes Obesity Metabolism

Nyström

et al. 2019

“…3,30 This program utilizes the unique features of the mandatory healthcare registries and corresponding healthcare systems in Sweden to identify all patients with T2D with filled prescriptions for a glucose-lowering drug (GLD) (Appendix, Section S1). 31…”

Section: Methodsmentioning

confidence: 99%

Dapagliflozin vs non‐SGLT‐2i treatment is associated with lower healthcare costs in type 2 diabetes patients similar to participants in the DECLARE‐TIMI 58 trial: A nationwide observational study

Norhammar

Diabetes Obesity Metabolism

Nyström

et al. 2019

Aims To investigate how the cardiovascular (CV) risk benefits of dapagliflozin translate into healthcare costs compared with other non‐sodium–glucose cotransporter‐2 inhibitor glucose‐lowering drugs (oGLDs) in a real‐world population with type 2 diabetes (T2D) that is similar to the population of the DECLARE‐TIMI 58 trial. Methods Patients initiating dapagliflozin or oGLDs between 2013 and 2016 in Swedish nationwide healthcare registries were included if they fulfilled inclusion and exclusion criteria of the DECLARE‐TIMI 58 trial (DECLARE‐like population). Propensity scores for the likelihood of dapagliflozin initiation were calculated, followed by 1:3 matching with initiators of oGLDs. Per‐patient cumulative costs for hospital healthcare (in‐ and outpatient) and for drugs were calculated from new initiation until end of follow‐up. Results A total of 24 828 patients initiated a new GLD; 6207 initiated dapagliflozin and 18 621 initiated an oGLD. After matching based on 96 clinical and healthcare cost variables, groups were balanced at baseline. Mean cumulative 30‐month healthcare cost per patient was similar in the dapagliflozin and oGLD groups ($11 807 and $11 906, respectively; difference, −$99; 95% CI, −$629, $483; P = 0.644). Initiation of dapagliflozin rather than an oGLD was associated with significantly lower hospital costs (−$658; 95% CI, −$1169, −$108; P = 0.024) and significantly higher drug costs ($559; 95% CI, $471, $648; P < 0.001). Hospital cost difference was related mainly to fewer CV‐ and T2D‐associated complications with use of dapagliflozin compared with use of an oGLD (−$363; 95% CI, −$665, −$61; P = 0.008). Conclusion In a nationwide, real‐world, DECLARE‐like population, dapagliflozin was associated with lower hospital costs compared with an oGLD, mainly as a result of reduced rates of CV‐ and T2D‐associated complications.

“…17 Detailed data on the data sources, see Supporting Information Appendix S1-section 1. 17 Detailed data on the data sources, see Supporting Information Appendix S1-section 1.…”

Section: Data Sourcesmentioning

confidence: 99%

“…The present work is part of the D360 Nordic programme, a largescale diabetes investigation program which utilizes the unique features of full coverage nationwide healthcare registries and public healthcare systems covering more than 25 million inhabitants in all the Nordic countries, to include all T2D patients with filled GLD prescriptions. 17 Detailed data on the data sources, see Supporting Information Appendix S1-section 1.…”

Section: Data Sourcesmentioning

confidence: 99%

Different patterns of second‐line treatment in type 2 diabetes after metformin monotherapy in Denmark, Finland, Norway and Sweden (D360 Nordic): A multinational observational study

Persson

Endocrino Diabet & Metabol

Lahtela

et al. 2018

Summary Aims The understanding of second‐line use of glucose‐lowering drugs (GLDs) in the general population with type 2 diabetes (T2D) treatment is important as recent results have shown cardiovascular benefits with sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA). Our aim was to describe second‐line GLD treatment patterns in four Nordic countries. Methods All T2D patients treated with GLD between 2006 and 2015 were identified in prescribed drug registries in Denmark, Finland, Norway and Sweden, and linked with National Patient and Cause of Death Registries. Second‐line treatment was defined as a prescription of a second GLD class following ≥6 months of metformin monotherapy. Index was the date of first dispense of the second‐line drug. Results A rapid uptake of newer GLDs (GLP‐1RA, DPP‐4i and SGLT‐2i) over the 10‐year observation period was seen in Denmark, Finland and Norway, while slower in Sweden. In 2015, 33,880 (3.1%) of 1,078,692 T2D patients initiated second‐line treatment, and newer GLDs were more commonly used in Finland (92%), Norway (71%) and Denmark (70%) vs Sweden (44%). In 2015, the use of older GLDs (insulin and sulphonylureas) was 7‐fold greater in Sweden compared to Finland (49% vs 7%), and 1.6‐fold greater compared with Denmark and Norway (49% vs 30% and 29%, respectively). Conclusions Despite comparable demography and healthcare systems in four neighbouring countries, surprisingly large differences in second‐line use of newer GLDs were found. With recent evidence of potential cardiovascular benefits with newer GLDs, such differences may have an important impact on cardiovascular outcomes.