Reasons for hospitalizations in patients with type 2 diabetes in the CANVAS programme: A secondary analysis

Abstract

Aim To determine the reasons for hospitalizations in the CANagliflozin cardioVascular Assessment Study (CANVAS) programme and the effects of the sodium‐glucose co‐transporter‐2 inhibitor canagliflozin on hospitalization. Materials and Methods A secondary analysis was performed on the CANVAS programme that included 10 142 participants with type 2 diabetes randomized to canagliflozin or placebo. The primary outcome was the rate of total (first plus all recurrent) all‐cause hospitalizations (ACH). Secondary outcomes were total hospitalizations categorized by the Medical Dictionary for Regulatory Activities hierarchy at the system organ class level, reported by investigators at each centre. Outcomes were assessed using negative binomial models. Results Of the 7115 hospitalizations reported, the most common reasons were cardiac disorders (23.7%), infections and infestations (15.0%), and nervous system disorders (9.0%). The rate of total ACH was lower in the canagliflozin group (n = 5795) compared with the placebo group (n = 4347): 197.9 versus 215.8 participants per 1000 patient‐years, respectively (rate ratio [RR] 0.92; 95% confidence interval [CI] 0.86, 0.98). Canagliflozin reduced the rate of total hospitalizations because of cardiac disorders (RR 0.81; 95% CI 0.75, 0.88). There was no significant difference between the canagliflozin and placebo groups in the rates of total hospitalizations because of infections and infestations (RR 0.96; 95% CI 0.86, 1.02) or nervous system disorders (RR 0.96; 95% CI 0.88, 1.05). Conclusions In the CANVAS programme, the most common reasons for hospitalization were cardiac disorders, infections and infestations, and nervous system disorders. Canagliflozin, compared with placebo, reduced the rate of total ACH.

Preventing all‐cause hospitalizations in type 2 diabetes with sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists: A narrative review and proposed clinical approach

“…In the CANVAS programme, which included populations with high risk for or established CVD, the risk for any hospitalization, a predefined secondary outcome, was 0.94 (95% CI 0.88‐1.00) in the canagliflozin‐treated arm compared with placebo 9 . In a post hoc analysis, there was an 8% (95% CI 2‐14) reduction in the rate of acute hospitalization (first and recurrent) in canagliflozin compared with placebo, which seemed to be consistent in populations with high risk of CVD and those with established CVD ( P interaction = 0.66) 3 . Also in this study, the three most common hospitalization aetiologies were cardiac disorders (23.7% of all hospitalizations), infections and infestations (15.0%), and nervous system‐related disorders (9.0%).…”

“…Also in this study, the three most common hospitalization aetiologies were cardiac disorders (23.7% of all hospitalizations), infections and infestations (15.0%), and nervous system‐related disorders (9.0%). The between‐arm differences in risk for cardiac‐, infectious‐, and nervous‐system‐related hospitalizations were 0.81 (95% CI 0.75‐0.88), 0.94 (95% CI 0.86‐1.02) and 0.96 (95% CI 0.88‐1.05), respectively 3 …”

“…The between-arm differences in risk for cardiac-, infectious-, and nervoussystem-related hospitalizations were 0.81 (95% CI 0.75-0.88), 0.94 (95% CI 0.86-1.02) and 0.96 (95% CI 0.88-1.05), respectively. 3 The SOLOIST-WHF study tested the SGLT2 + 1 inhibitor sotagliflozin in patients with T2D and a recent worsening of heart failure (HF); assessment of the number of DAOH was included in the protocol. This endpoint considers the length of all hospital admissions and the competing outcome of death.…”

“…The estimated costs of diabetes‐related preventable hospitalizations in the United States increase at a 1.6% annual rate, derived mainly from higher diabetes prevalence 2 . Cardiovascular‐, infectious‐ and nervous‐system‐related aetiologies comprise the main portion of acute hospitalizations in patients with type 2 diabetes (T2D) 3,4 . However, the presence of diabetes is associated with a higher risk of hospitalizations for various other reasons.…”

“…ACHA-based outcomes are often limited by lack of specificity, difficulty in sorting emergency versus elective hospitalizations, reporting inconsistencies, seasonal fluctuation and pandemics, alterations due to sociodemographic status, and regional variations in treatment approaches, healthcare systems and regulations. Endpoints related to ACHAs are not standardized and may include first or recurrent hospitalization event rate, 3,4,9,10 percent of admitted patients, 8 time to hospital admission, 10,11 days-alive-andout-of-hospital (DAOH), or percent of DAOH out of potential followup. 8 These endpoints differ in how they address hospitalization duration or other competing risk events (eg, death).…”