Real-World Impact of HbA1c Reduction on Treatment Intensification and HbA1c Goal Attainment in T2DM Patients Initiated on SGLT2i
Authors: BRUNTON STEPHEN , ROZJABEK HEATHER M. , PILON DOMINIC , LAFEUILLE MARIE-HELENE , KAMSTRA RHIANNON L. , WYNANT WILLY , BOOKHART BRAHIM , LEFEBVRE PATRICK 
Published: June 2018

In patients with T2DM, canagliflozin reduces HbA1c by 0.2% vs. other SGLT2is, at their highest doses. This study evaluated the impact of an HbA1c reduction on treatment intensification and HbA1c goals attainment in TD2M patients initiated on a SGLT2i.
The IQVIATM Real-World Data Adjudicated Claims - U.S. and the IQVIATM Real-World Data EMRs - U.S. databases (09/30/2012-03/31/2016) were used to identify adults with T2DM initiated on SGLT2i (index date) who had an HbA1c pre- and post-index. Patients were excluded if they had &lt;6 months of eligibility prior to index (baseline), baseline use of GLP-1s or insulins, and chronic or diabetic kidney disease. HbA1c change was defined as the difference between the first HbA1c post-index and the last HbA1c pre-index. Cox regression models were used assess treatment intensification (GLP-1 or insulin initiation) and goal attainment (HbA1c&lt;7%, &lt;8%, and &gt;9%; among patients not at goal at baseline) adjusting for HbA1c change and baseline characteristics. Patients were observed up to the earliest of one year after first HbA1c or end of eligibility period. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. A total of 938 patients were selected. The mean age was 55 years, 43% were females, and the mean HbA1c was 8.5%. Following SGLT2i initiation, each 0.2% HbA1c reduction was associated with a 10% lower risk of treatment intensification (HR [95% CI]: 0.90 [0.86-0.92]). Similarly, each HbA1c reduction of 0.2% was associated with an 8 to 17% increase in the likelihood of achieving the treatment goals (HbA1c&lt;7% HR [95% CI]: 1.17 [1.12-1.21]; HbA1c&lt;8% HR [95% CI]: 1.[1.04-1.10]). Finally, each 0.2% HbA1c reduction was also associated with a 15% decreased likelihood of having an HbA1c&gt;9% (HR [95% CI]: 0.85 [0.79-0.88]).
In this study of T2DM patients, each HbA1c reduction of 0.2% following the initiation of a SGLT2i was associated with a significant positive impact on treatment intensification and HbA1c goal attainment.

Disclosure
S. Brunton: Advisory Panel; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc.. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Advisory Panel; Self; Sanofi US, Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Eli Lilly and Company. H.M. Rozjabek: Employee; Self; Janssen Scientific Affairs, LLC. D. Pilon: Other Relationship; Self; Janssen Scientific Affairs, LLC., Novartis Pharmaceuticals Corporation. M. Lafeuille: Other Relationship; Self; Analysis Group. R.L. Kamstra: Other Relationship; Self; Analysis Group. W. Wynant: Research Support; Self; Janssen Scientific Affairs, LLC., AbbVie Inc., Genentech, Inc., Taiho Oncology, Inc. B. Bookhart: Employee; Self; Janssen Scientific Affairs, LLC. P. Lefebvre: Research Support; Self; Janssen Pharmaceuticals, Inc..