Study With Dapagliflozin
Condition: Diabetes Mellitus Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Observational

Summary: 
      The study will retrospectively collect clinical variables and socio-demographic data from
      medical records of patients with T2DM initiating treatment with dapagliflozin after the
      previous failure/inefficiency of other treatment options (defined as non-achievement of
      target Hb1Ac) and according to the officially approved indication as per instruction for the
      use of medicinal product.

      It is expected that the best available data regarding clinical variables and patient
      socio-demographic profiled will be collected from the patient medical records at up to 40
      major Russian outpatient clinics/centers specialized in the treatment and management of T2DM
      patients.

      There are 2 time points:

        -  Baseline data: baseline data are defined as data available within 3 months prior to the
           first dose of dapagliflozin. In case of presence of multiple data values within baseline
           period the most recent pre-dose value will be selected

        -  Follow-up data: any post-baseline data will be considered as follow-up but the primary
           analysis will be focused on data available at 6 plus/minus 3 months after the initiation
           of dapagliflozin. In case of discontinuation dapagliflozin, data will be collected at
           routine visit within 3-month time frame after the last dose
    

Detailed description: 
      Objectives and Hypotheses:

      Primary objective:

      To describe HbA1c (glycosylated haemoglobin) change from baseline to follow-up

      Secondary objectives:

      Clinical data:

        -  To estimate percentage (%) of patients with reduction of HbA1c by 0.5% or more from
           baseline to follow-up

        -  To estimate percentage (%) of patients reaching the therapeutic glycemic response (HbA1c
           <7.0%) from baseline to follow-up

        -  To describe change of fasting blood glucose from baseline to follow-up

        -  To estimate change of body weight from baseline to follow-up

        -  To estimate percentage (%) of patients with body weight reduction by at least 5% from
           baseline to follow-up

        -  To estimate percentage (%) of patients with reduction of HbA1c by 0.5% or more and body
           weight reduction by at least 5% from baseline to follow-up

        -  To describe change of systolic and diastolic blood pressure from baseline to follow-up
           (systolic and diastolic, in mmHg)

      Methods:

      Study design:

      The study will retrospectively collect clinical variables and socio-demographic data from
      medical records of patients with T2DM initiating treatment with dapagliflozin after the
      previous failure/inefficiency of other treatment options (defined as non-achievement of
      target Hb1Ac) and according to the officially approved indication as per instruction for the
      use of medicinal product.

      It is expected that the best available data regarding clinical variables and patient
      socio-demographic profiled will be collected from the patient medical records at up to 40
      major Russian outpatient clinics/centers specialized in the treatment and management of T2DM
      patients.

      There are 2 time points:

        -  Baseline data: baseline data are defined as data available within 3 months prior to the
           first dose of dapagliflozin. In case of presence of multiple data values within baseline
           period the most recent pre-dose value will be selected

        -  Follow-up data: any post-baseline data will be considered as follow-up but the primary
           analysis will be focused on data available at 6 plus/minus 3 months after the initiation
           of dapagliflozin. In case of discontinuation dapagliflozin, data will be collected at
           routine visit within 3-month time frame after the last dose.

      Data Source(s):

      Participating investigators should be physicians-endocrinologists working in approximately 12
      outpatient clinics specialized in management of patients with T2DM in Moscow. There is no
      current legislation on EMR in Russia, so, paper medical records will be utilized, and data
      collection using electronic CRFs will be done.

      Study Population:

      T2DM patients previously uncontrolled on standard therapy (mono-, double therapy with OADs:
      metformin, SU or DPP-4 inhibitors or on insulin) initiating treatment with dapagliflozin as
      monotherapy, combination with OADs or as add-on to insulin with available data on Hb1c within
      3 months prior to the first dose of dapagliflozin. All consecutive patients at the clinic in
      inclusion period who meet inclusion and exclusion criteria will be included.

      Exposure(s):

      Only patients initiating treatment with dapagliflozin as monotherapy, combination with OADs
      or as add-on to insulin will be included in the study.

      Outcome(s):

      Population parameters

        -  Date of birth

        -  Gender

        -  Level of education

        -  Level of income

        -  Ethnicity/race

        -  Living conditions

        -  Working conditions All documented macro- and microvascular T2DM complications and
           concomitant medications (antidiabetic drugs, statins, ACE inhibitors, sartans,
           beta-blockers, calcium channel antagonists) will be collected for whole course of
           dapagliflozin administration.

      Clinical parameters

        -  Hb1Ac

        -  Fasting glucose

        -  Body weight

        -  Blood pressure (systolic and diastolic)

      Sample Size Estimations:

      Approximate sample size is 850 patients.

      Statistical Analysis:

      Epidemiological methods mainly will be used to represent the study data. A descriptive
      analysis approach will be used to analyse study objectives. Descriptive statistics will be
      used to analyse the study population, baseline data and clinical outcomes. The descriptive
      statistics will include mean, standard deviation, median, minimum and maximum, range, number
      of valid cases for continuous variables, number, percentage, and distribution for categorical
      variables. The percentage will be given with the relevant two-sided 95% confidence intervals.

      Only available data will be analyzed; no missing values imputation will be applied. Only
      patients with available data on HbA1c both within 3 months prior to the first dose of
      dapagliflozin and at 6±3 months after the initiation of dapagliflozin will be included in the
      main analysis.

      All other baseline, effectiveness parameters will be tabulated, assessed in subgroups where
      available..

      In order to evaluate the association between achievement of the HbA1C goals and patient
      characteristics, the multivariate logistic regression model was developed. A binary
      categorical attribute-HbA1C within/outside < 7% at 6±3 months after the initiation of
      dapagliflozin -serves as a dependable variable in this model
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        T2DM patients previously uncontrolled on standard therapy (mono-, double therapy with OADs:
        metformin, SU or DPP-4 inhibitors or on insulin) initiating treatment with dapagliflozin as
        monotherapy, combination with OADs or as add-on to insulin with available data on Hb1c
        within 3 months prior to the first dose of dapagliflozin. All consecutive patients at the
        clinic in inclusion period who meet inclusion and exclusion criteria will be included.
      
Keywords: dapagliflozin,; Russia,; retrospective study,; diabetes mellitus type 2