2224-PUB: The Effect of Diabetes Duration on Response to Empagliflozin: Data from the Association of British Clinical Diabetologists (ABCD) Audit Programme
Authors: CRABTREE THOMAS S.J. , ADAMSON KAREN , BICKERTON ALEX , PHILLIPS SUZANNE M. , EVANS ALISON , ROBINSON ANTHONY M. , ATKIN MARC , MORRIS DAVID S. , WILLIAMS DAVID M. , STEPHENS JEFFREY W. , SENNIK DEVESH K. , ROHILLA ANURITA , CULL MELISSA L. , RAGHAVAN RAJEEV P. , YADAGIRI MAHENDER , GALLEN IAN W. , RYDER ROBERT E. 
Published: June 2020

Background: Data previously presented from our audit programme showed that sodium-glucose co-transporter 2 inhibitors (SGLT2s) remain equally effective at reducing HbA1c irrespective of duration of diabetes. This analysis was performed to establish if the same held true for empagliflozin.

Methods: Data extracted from the ABCD nationwide empagliflozin audit was stratified into groups based on duration of diabetes: group 1 (&lt;5yrs; n=2320), group 2 (≥5yrs, &lt;10yrs; n=1516), group 3 (≥10yrs; n=2224). Data was analysed using paired t-tests and ANOVA in Stata 16.

Results: 6060 datasets were included with mean (±SD) age 59.5yrs (±10.4), 61.1% male, 86% Caucasian (where known), BMI 33.2kg/m2 (±7.2), baseline HbA1c 9.2% (±1.6%) and weight 98.1kg (±21.0). These were broadly similar across all 3 sub-groups apart from age, which understandably increased with duration of diabetes (group 1 57.7yrs±10.8 v group 3 62.0yrs±9.7). Decreases in HbA1c (%) from baseline were observed in all groups, greatest in group 1 (-1.27%; 95% CI -1.19%, -1.35%) and least pronounced in group 3 (-0.9%; 95% CI -0.83%, -0.97%). ANOVA showed significant differences amongst the groups for HbA1c change (P&lt;0.001) but not for weight, BMI or blood pressure. Further analysis has demonstrated no significant difference between HbA1c reductions in group 1 and 2 (P=0.79) but very significant differences (P&lt;0.001) between both groups 1 and 2 and group 3, suggesting the change in response occurs at around the 10 year mark.

Conclusions: This analysis demonstrates statistically significant differences in the magnitude of HbA1c change (due to empagliflozin use) in those with shorter v longer durations of diabetes, appearing to occur after 10 years. Although the pattern is generally comparable to other SGLT2s the statistical significance is likely to have been increased from previous data due to a larger sample. The clinical significance of such minor differences in effect is not clear.

Disclosure

T.S.J. Crabtree: None. K. Adamson: None. A. Bickerton: None. S.M. Phillips: None. A. Evans: Other Relationship; Self; AstraZeneca. A.M. Robinson: None. M. Atkin: Speaker’s Bureau; Self; AstraZeneca, Napp Pharmaceuticals. D.S. Morris: None. D.M. Williams: None. J.W. Stephens: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Napp Pharmaceuticals, Novo Nordisk A/S. D.K. Sennik: Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. A. Rohilla: None. M.L. Cull: None. R.P. Raghavan: Research Support; Self; Allergan plc. Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Napp Pharmaceuticals, Takeda UK. Other Relationship; Self; Napp Pharmaceuticals. M. Yadagiri: None. I.W. Gallen: None. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S.