Background
Methods
Study design and setting
Study population
Variables and outcomes
Statistical analysis
Subgroup and sensitivity analyses
Results
Patient characteristics
Demographics | SGLT2i initiators with DKD (N = 6389) | Commercial insurance (N = 2284) | Medicare insurance (N = 4105) | Low CV risk (N = 2797) | Moderate CV risk (N = 3237) | High CV risk (N = 355) |
---|---|---|---|---|---|---|
Age | ||||||
Mean (SD) | 65.5 (10.6) | 56.4 (8.7) | 70.6 (7.8) | 64.4 (10.6) | 66.4 (10.5) | 66.7 (10.3) |
Median [IQR] | 67 [59, 73] | 58 [51, 62] | 71 [67, 75] | 66 [57, 72] | 68 [60, 73] | 68 [61, 74] |
Sex | ||||||
Female, n (%) | 3006 (47.0%) | 880 (38.5%) | 2126 (51.8%) | 1341 (47.9%) | 1510 (46.6%) | 155 (43.7%) |
Male, n (%) | 3382 (52.9%) | 1403 (61.4%) | 1979 (48.2%) | 1455 (52.0%) | 1727 (53.4%) | 200 (56.3%) |
Unknown, n (%) | 1 (0.0%) | 1 (0.0%) | 0 (0.0%) | 1 (0.0%) | 0 (0.0%) | 0 (0.0%) |
Race | ||||||
White, n (%) | 3062 (47.9%) | 1297 (56.8%) | 1765 (43.0%) | 1486 (53.1%) | 1416 (43.7%) | 160 (45.1%) |
Asian, n (%) | 419 (6.6%) | 145 (6.3%) | 274 (6.7%) | 190 (6.8%) | 214 (6.6%) | 15 (4.2%) |
Black, n (%) | 773 (12.1%) | 267 (11.7%) | 506 (12.3%) | 337 (12.0%) | 381 (11.8%) | 55 (15.5%) |
Hispanic, n (%) | 1484 (23.2%) | 469 (20.5%) | 1015 (24.7%) | 515 (18.4%) | 879 (27.2%) | 90 (25.4%) |
Missing, n (%) | 651 (10.2%) | 106 (4.6%) | 545 (13.3%) | 269 (9.6%) | 347 (10.7%) | 35 (9.9%) |
Region | ||||||
Northeast, n (%) | 564 (8.8%) | 155 (6.8%) | 409 (10.0%) | 235 (8.4%) | 285 (8.8%) | 44 (12.4%) |
Midwest, n (%) | 433 (6.8%) | 235 (10.3%) | 198 (4.8%) | 236 (8.4%) | 166 (5.1%) | 31 (8.7%) |
South, n (%) | 3779 (59.1%) | 1379 (60.4%) | 2400 (58.5%) | 1616 (57.8%) | 1937 (59.8%) | 226 (63.7%) |
West, n (%) | 1584 (24.8%) | 511 (22.4%) | 1073 (26.1%) | 700 (25.0%) | 832 (25.7%) | 52 (14.6%) |
Missing, n (%) | 29 (0.5%) | 4 (0.2%) | 25 (0.6%) | 10 (0.4%) | 17 (0.5%) | 2 (0.6%) |
Provider specialty | ||||||
Endocrinologist, n (%) | 469 (7.3%) | 206 (9.0%) | 263 (6.4%) | 145 (5.2%) | 292 (9.0%) | 32 (9.0%) |
Nephrologist, n (%) | 35 (0.5%) | 12 (0.5%) | 23 (0.6%) | 14 (0.5%) | 17 (0.5%) | 4 (1.1%) |
Cardiologist, n (%) | 91 (1.4%) | 24 (1.1%) | 67 (1.6%) | 36 (1.3%) | 43 (1.3%) | 12 (3.4%) |
GP/Internist, n (%) | 1556 (24.4%) | 424 (18.6%) | 1132 (27.6%) | 645 (23.1%) | 825 (25.5%) | 86 (24.2%) |
Urologist, n (%) | 12 (0.2%) | 2 (0.1%) | 10 (0.2%) | 5 (0.2%) | 6 (0.2%) | 1 (0.3%) |
IP facility provider, n (%) | 72 (1.1%) | 27 (1.2%) | 45 (1.1%) | 22 (0.8%) | 39 (1.2%) | 11 (3.1%) |
OP facility provider, n (%) | 61 (1.0%) | 12 (0.5%) | 49 (1.2%) | 22 (0.8%) | 36 (1.1%) | 3 (0.8%) |
Missing, n (%) | 2067 (32.4%) | 635 (27.8%) | 1432 (34.9%) | 820 (29.3%) | 1122 (34.7%) | 125 (35.2%) |
Insurance type | ||||||
Commercial, n (%) | 2284 (35.7%) | 2284 (100.0%) | 0 (0.0%) | 1234 (44.1%) | 957 (29.6%) | 93 (26.2%) |
Medicare, n (%) | 4105 (64.3%) | 0 (0.0%) | 4105 (100.0%) | 1563 (55.9%) | 2280 (70.4%) | 262 (73.8%) |
SGLT2i initiators with DKD (N = 6389) | Commercial insurance (N = 2284) | Medicare insurance (N = 4105) | Low CV risk (N = 2797) | Moderate CV risk (N = 3237) | High CV risk (N = 355) | |
---|---|---|---|---|---|---|
Comorbidities | ||||||
DSCI score | ||||||
Mean (SD) | 2.5 (2.0) | 1.6 (1.7) | 2.9 (2.0) | 1.7 (1.5) | 3.0 (2.1) | 4.5 (2.0) |
Median [IQR] | 2 [1, 4] | 1 [0, 2] | 3 [1, 4] | 1 [0, 3] | 3 [1, 4] | 4 [3, 6] |
Charlson-Quan score | ||||||
Mean (SD) | 1.6 (1.8) | 1.5 (1.7) | 1.6 (1.9) | 1.7 (1.8) | 1.4 (1.8) | 2.5 (2.1) |
Median [IQR] | 1 [0, 2] | 1 [0, 2] | 1 [0, 2] | 1 [0, 3] | 1 [0, 2] | 2 [1, 3] |
Acidosis, n (%) | 89 (1.4%) | 21 (0.9%) | 68 (1.7%) | 25 (0.9%) | 34 (1.1%) | 30 (8.5%) |
ACS, n (%) | 352 (5.5%) | 73 (3.2%) | 279 (6.8%) | 37 (1.3%) | 196 (6.1%) | 119 (33.5%) |
Angina pectoris, n (%) | 1671 (26.2%) | 397 (17.4%) | 1274 (31.0%) | 462 (16.5%) | 955 (29.5%) | 254 (71.5%) |
Atherosclerotic gangrene, n (%) | 9 (0.1%) | 2 (0.1%) | 7 (0.2%) | 0 (0.0%) | 1 (0.0%) | 8 (2.3%) |
Atrial fibrillation, n (%) | 87 (1.4%) | 19 (0.8%) | 68 (1.7%) | 24 (0.9%) | 22 (0.7%) | 41 (11.5%) |
CABG or PTCA, n (%) | 146 (2.3%) | 45 (2.0%) | 101 (2.5%) | 10 (0.4%) | 43 (1.3%) | 93 (26.2%) |
Cancer excluding NMSC, n (%) | 488 (7.6%) | 128 (5.6%) | 360 (8.8%) | 213 (7.6%) | 243 (7.5%) | 32 (9.0%) |
COPD, n (%) | 1271 (19.9%) | 306 (13.4%) | 965 (23.5%) | 423 (15.1%) | 709 (21.9%) | 139 (39.2%) |
Coronary artery disease, n (%) | 1437 (22.5%) | 308 (13.5%) | 1129 (27.5%) | 296 (10.6%) | 895 (27.6%) | 246 (69.3%) |
Depression, n (%) | 955 (14.9%) | 237 (10.4%) | 718 (17.5%) | 302 (10.8%) | 565 (17.5%) | 88 (24.8%) |
Diabetic foot infection, n (%) | 304 (4.8%) | 98 (4.3%) | 206 (5.0%) | 81 (2.9%) | 160 (4.9%) | 63 (17.7%) |
Diabetic retinopathy, n (%) | 1107 (17.3%) | 317 (13.9%) | 790 (19.2%) | 432 (15.4%) | 601 (18.6%) | 74 (20.8%) |
Edema, n (%) | 833 (13.0%) | 218 (9.5%) | 615 (15.0%) | 277 (9.9%) | 446 (13.8%) | 110 (31.0%) |
Fatigue/sleep disorder, n (%) | 1571 (24.6%) | 479 (21.0%) | 1092 (26.6%) | 572 (20.5%) | 823 (25.4%) | 176 (49.6%) |
GERD, n (%) | 1308 (20.5%) | 345 (15.1%) | 963 (23.5%) | 465 (16.6%) | 705 (21.8%) | 138 (38.9%) |
Heart failure, n (%) | 620 (9.7%) | 106 (4.6%) | 514 (12.5%) | 142 (5.1%) | 345 (10.7%) | 133 (37.5%) |
Hyperkalemia, n (%) | 348 (5.4%) | 98 (4.3%) | 250 (6.1%) | 116 (4.1%) | 172 (5.3%) | 60 (16.9%) |
Hyperlipidemia, n (%) | 5615 (87.9%) | 2020 (88.4%) | 3595 (87.6%) | 2398 (85.7%) | 2881 (89.0%) | 336 (94.6%) |
Hypertension, n (%) | 5897 (92.3%) | 2060 (90.2%) | 3837 (93.5%) | 2506 (89.6%) | 3040 (93.9%) | 351 (98.9%) |
Hypoglycemia, n (%) | 129 (2.0%) | 31 (1.4%) | 98 (2.4%) | 31 (1.1%) | 69 (2.1%) | 29 (8.2%) |
Hypokalemia, n (%) | 193 (3.0%) | 65 (2.8%) | 128 (3.1%) | 46 (1.6%) | 108 (3.3%) | 39 (11.0%) |
Hyponatremia, n (%) | 146 (2.3%) | 25 (1.1%) | 121 (2.9%) | 32 (1.1%) | 63 (1.9%) | 51 (14.4%) |
Hypotension, n (%) | 180 (2.8%) | 49 (2.1%) | 131 (3.2%) | 45 (1.6%) | 78 (2.4%) | 57 (16.1%) |
Infectious disease, n (%) | 1673 (26.2%) | 465 (20.4%) | 1208 (29.4%) | 546 (19.5%) | 969 (29.9%) | 158 (44.5%) |
Intestinal enteropathy, n (%) | 744 (11.6%) | 197 (8.6%) | 547 (13.3%) | 242 (8.7%) | 402 (12.4%) | 100 (28.2%) |
Liver disease, n (%) | 508 (8.0%) | 185 (8.1%) | 323 (7.9%) | 182 (6.5%) | 283 (8.7%) | 43 (12.1%) |
MC disease, n (%) | 3467 (54.3%) | 955 (41.8%) | 2512 (61.2%) | 1306 (46.7%) | 1922 (59.4%) | 239 (67.3%) |
Obesity, n (%) | 2759 (43.2%) | 1006 (44.0%) | 1753 (42.7%) | 980 (35.0%) | 1567 (48.4%) | 212 (59.7%) |
Osteoarthritis, n (%) | 1483 (23.2%) | 359 (15.7%) | 1124 (27.4%) | 592 (21.2%) | 758 (23.4%) | 133 (37.5%) |
Pain disorders, n (%) | 4487 (70.2%) | 1413 (61.9%) | 3074 (74.9%) | 1772 (63.4%) | 2385 (73.7%) | 330 (93.0%) |
PAD, n (%) | 1244 (19.5%) | 171 (7.5%) | 1073 (26.1%) | 0 (0.0%) | 3031 (93.6%) | 301 (84.8%) |
PVD, n (%) | 1382 (21.6%) | 219 (9.6%) | 1163 (28.3%) | 168 (6.0%) | 1046 (32.3%) | 168 (47.3%) |
Prevalent anemia, n (%) | 1371 (21.5%) | 348 (15.2%) | 1023 (24.9%) | 494 (17.7%) | 695 (21.5%) | 182 (51.3%) |
Prior cardiac procedure, n (%) | 3318 (51.9%) | 992 (43.4%) | 2326 (56.7%) | 1164 (41.6%) | 1819 (56.2%) | 335 (94.4%) |
Proteinuria, n (%) | 962 (15.1%) | 410 (18.0%) | 552 (13.4%) | 362 (12.9%) | 542 (16.7%) | 58 (16.3%) |
Pyelonephritis, n (%) | 32 (0.5%) | 10 (0.4%) | 22 (0.5%) | 8 (0.3%) | 19 (0.6%) | 5 (1.4%) |
Resistant hypertension, n (%) | 1229 (19.2%) | 319 (14.0%) | 910 (22.2%) | 451 (16.1%) | 663 (20.5%) | 115 (32.4%) |
Respiratory failure, n (%) | 151 (2.4%) | 32 (1.4%) | 119 (2.9%) | 27 (1.0%) | 56 (1.7%) | 68 (19.2%) |
Sleep apnea, n (%) | 1135 (17.8%) | 428 (18.7%) | 707 (17.2%) | 431 (15.4%) | 599 (18.5%) | 105 (29.6%) |
TIA, n (%) | 142 (2.2%) | 39 (1.7%) | 103 (2.5%) | 26 (0.9%) | 80 (2.5%) | 36 (10.1%) |
Lifestyle factors | ||||||
Alcohol abuse, n (%) | 74 (1.2%) | 18 (0.8%) | 56 (1.4%) | 21 (0.8%) | 42 (1.3%) | 11 (3.1%) |
Influenza vaccination, n (%) | 1897 (29.7%) | 948 (41.5%) | 949 (23.1%) | 823 (29.4%) | 970 (30.0%) | 104 (29.3%) |
Smoking or nicotine dependence, n (%) | 465 (7.3%) | 172 (7.5%) | 293 (7.1%) | 161 (5.8%) | 250 (7.7%) | 54 (15.2%) |
Smoking cessation, n (%) | 274 (4.3%) | 96 (4.2%) | 178 (4.3%) | 124 (4.4%) | 132 (4.1%) | 18 (5.1%) |
Laboratory value | ||||||
HbA1c level | ||||||
Mean (SD) | 9.2 (3.9) | 9.2 (2.9) | 9.2 (4.4) | 8.9 (3.6) | 9.4 (4.3) | 9.1 (3.0) |
Median [IQR] | 8.4 [7.5, 9.8] | 8.5 [7.5, 10.1] | 8.4 [7.5, 9.8] | 8.3 [7.4, 9.6] | 8.6 [7.6, 10.1] | 8.5 [7.4, 9.9] |
Missing, n (%) | 516 (8.1%) | 178 (7.8%) | 338 (8.2%) | 236 (8.4%) | 244 (7.5%) | 36 (10.1%) |
eGFR stage* | ||||||
G1, n (%) | 754 (11.8%) | 519 (22.7%) | 235 (5.7%) | 365 (13.0%) | 360 (11.1%) | 29 (8.2%) |
G2, n (%) | 1178 (18.4%) | 468 (20.5%) | 710 (17.3%) | 511 (18.3%) | 602 (18.6%) | 65 (18.3%) |
G3a, n (%) | 2025 (31.7%) | 590 (25.8%) | 1435 (35.0%) | 994 (35.5%) | 903 (27.9%) | 128 (36.1%) |
G3b, n (%) | 670 (10.5%) | 118 (5.2%) | 552 (13.4%) | 275 (9.8%) | 343 (10.6%) | 52 (14.6%) |
G4, n (%) | 71 (1.1%) | 9 (0.4%) | 62 (1.5%) | 26 (0.9%) | 35 (1.1%) | 10 (2.8%) |
G5, n (%) | 7 (0.1%) | 4 (0.2%) | 3 (0.1%) | 2 (0.1%) | 5 (0.2%) | 0 (0.0%) |
Missing, n (%) | 1684 (26.4%) | 576 (25.2%) | 1108 (27.0%) | 624 (22.3%) | 989 (30.6%) | 71 (20.0%) |
UACR stage* | ||||||
A1, n (%) | 794 (12.4%) | 267 (11.7%) | 527 (12.8%) | 374 (13.4%) | 384 (11.9%) | 36 (10.1%) |
A2, n (%) | 2771 (43.4%) | 1152 (50.4%) | 1619 (39.4%) | 1107 (39.6%) | 1544 (47.7%) | 120 (33.8%) |
A3, n (%) | 916 (14.3%) | 323 (14.1%) | 593 (14.4%) | 350 (12.5%) | 512 (15.8%) | 54 (15.2%) |
Missing, n (%) | 1908 (29.9%) | 542 (23.7%) | 1366 (33.3%) | 966 (34.5%) | 797 (24.6%) | 145 (40.8%) |
Elevated hematocrit, n (%) | 179 (2.8%) | 76 (3.3%) | 103 (2.5%) | 72 (2.6%) | 99 (3.1%) | 8 (2.3%) |
Rate of eGFR decline per year of follow-up | ||||||
For cardio-kidney events | ||||||
Mean (SD) | 8.7 (13.6) | 7.6 (10.9) | 9.4 (15.1) | 7.2 (11.9) | 9.9 (15.2) | 12.4 (13.1) |
Median [IQR] | 4.5 [2.1, 9.4] | 4.4 [2.1, 9.0] | 4.7 [2.1, 10.1] | 4.2 [1.9, 7.8] | 4.9 [2.6, 11.2] | 6.7 [1.7, 18.3] |
Missing, n (%) | 5761 (90.2%) | 2026 (88.7%) | 3735 (91.0%) | 2477 (88.6%) | 2959 (91.4%) | 325 (91.5%) |
For treatment failure | ||||||
Mean (SD) | 4.4 (6.8) | 4.8 (6.3) | 4.1 (7.2) | – | – | – |
Median [IQR] | 2.6 [1.3, 5.0] | 2.8 [1.5, 5.2] | 2.5 [1.2, 4.8] | – | – | – |
Missing, n (%) | 5337 (83.5%) | 1865 (81.7%) | 3472 (84.6%) | – | – | – |
SGLT2i initiators with DKD (N = 6389) | Commercial insurance (N = 2284) | Medicare insurance (N = 4105) | Low CV risk (N = 2797) | Moderate CV risk (N = 3237) | High CV risk (N = 355) | |
---|---|---|---|---|---|---|
T2D medication | ||||||
Metformin, n (%) | 4545 (71.1%) | 1739 (76.1%) | 2806 (68.4%) | 2063 (73.8%) | 2256 (69.7%) | 226 (63.7%) |
Any second LOT, n (%) | 5528 (86.5%) | 1961 (85.9%) | 3567 (86.9%) | 2385 (85.3%) | 2834 (87.6%) | 309 (87.0%) |
SU, n (%) | 3093 (48.4%) | 1004 (44.0%) | 2089 (50.9%) | 1387 (49.6%) | 1555 (48.0%) | 151 (42.5%) |
TZD, n (%) | 848 (13.3%) | 273 (12.0%) | 575 (14.0%) | 371 (13.3%) | 436 (13.5%) | 41 (11.5%) |
DPP4i, n (%) | 2201 (34.4%) | 785 (34.4%) | 1416 (34.5%) | 1024 (36.6%) | 1074 (33.2%) | 103 (29.0%) |
GLP1ra, n (%) | 1385 (21.7%) | 680 (29.8%) | 705 (17.2%) | 551 (19.7%) | 763 (23.6%) | 71 (20.0%) |
Basal insulin, n (%) | 2249 (35.2%) | 801 (35.1%) | 1448 (35.3%) | 812 (29.0%) | 1258 (38.9%) | 179 (50.4%) |
AGI, n (%) | 58 (0.9%) | 13 (0.6%) | 45 (1.1%) | 22 (0.8%) | 33 (1.0%) | 3 (0.8%) |
Meglitinide, n (%) | 170 (2.7%) | 55 (2.4%) | 115 (2.8%) | 84 (3.0%) | 73 (2.3%) | 13 (3.7%) |
Any two second LOTs, n (%) | 2974 (46.5%) | 1042 (45.6%) | 1932 (47.1%) | 1222 (43.7%) | 1588 (49.1%) | 164 (46.2%) |
SU + TZD, n (%) | 391 (6.1%) | 122 (5.3%) | 269 (6.6%) | 180 (6.4%) | 199 (6.1%) | 12 (3.4%) |
SU + DPP4i, n (%) | 1010 (15.8%) | 342 (15.0%) | 668 (16.3%) | 490 (17.5%) | 488 (15.1%) | 32 (9.0%) |
SU + GLP1ra, n (%) | 377 (5.9%) | 183 (8.0%) | 194 (4.7%) | 164 (5.9%) | 199 (6.1%) | 14 (3.9%) |
SU + basal insulin, n (%) | 569 (8.9%) | 185 (8.1%) | 384 (9.4%) | 224 (8.0%) | 307 (9.5%) | 38 (10.7%) |
TZD + DPP4i, n (%) | 249 (3.9%) | 88 (3.9%) | 161 (3.9%) | 124 (4.4%) | 116 (3.6%) | 9 (2.5%) |
TZD + GLP1ra, n (%) | 118 (1.8%) | 55 (2.4%) | 63 (1.5%) | 53 (1.9%) | 57 (1.8%) | 8 (2.3%) |
TZD + basal insulin, n (%) | 152 (2.4%) | 54 (2.4%) | 98 (2.4%) | 60 (2.1%) | 84 (2.6%) | 8 (2.3%) |
DPP4i + basal insulin, n (%) | 430 (6.7%) | 142 (6.2%) | 288 (7.0%) | 157 (5.6%) | 239 (7.4%) | 34 (9.6%) |
GLP1ra + basal insulin, n (%) | 483 (7.6%) | 233 (10.2%) | 250 (6.1%) | 166 (5.9%) | 291 (9.0%) | 26 (7.3%) |
Basal + mealtime insulin, n (%) | 826 (12.9%) | 253 (11.1%) | 573 (14.0%) | 276 (9.9%) | 478 (14.8%) | 72 (20.3%) |
CV medication | ||||||
Alpha blocker, n (%) | 194 (3.0%) | 45 (2.0%) | 149 (3.6%) | 80 (2.9%) | 99 (3.1%) | 15 (4.2%) |
ACEi/ARB, n (%) | 5263 (82.4%) | 1831 (80.2%) | 3432 (83.6%) | 2282 (81.6%) | 2682 (82.9%) | 299 (84.2%) |
DRI, n (%) | 7 (0.1%) | 0 (0.0%) | 7 (0.2%) | 4 (0.1%) | 3 (0.1%) | 0 (0.0%) |
Antiplatelet, n (%) | 957 (15.0%) | 268 (11.7%) | 689 (16.8%) | 228 (8.2%) | 560 (17.3%) | 169 (47.6%) |
Anticoagulant, n (%) | 513 (8.0%) | 117 (5.1%) | 396 (9.6%) | 188 (6.7%) | 251 (7.8%) | 74 (20.8%) |
Aspirin, n (%) | 99 (1.5%) | 88 (3.9%) | 11 (0.3%) | 31 (1.1%) | 53 (1.6%) | 15 (4.2%) |
Beta blocker, n (%) | 3065 (48.0%) | 838 (36.7%) | 2227 (54.3%) | 1160 (41.5%) | 1637 (50.6%) | 268 (75.5%) |
CCB, n (%) | 2548 (39.9%) | 748 (32.7%) | 1800 (43.8%) | 1059 (37.9%) | 1328 (41.0%) | 161 (45.4%) |
Central alpha agonist, n (%) | 298 (4.7%) | 87 (3.8%) | 211 (5.1%) | 113 (4.0%) | 162 (5.0%) | 23 (6.5%) |
Diuretic, n (%) | 3462 (54.2%) | 1068 (46.8%) | 2394 (58.3%) | 1443 (51.6%) | 1771 (54.7%) | 248 (69.9%) |
ENaC, n (%) | 179 (2.8%) | 63 (2.8%) | 116 (2.8%) | 92 (3.3%) | 80 (2.5%) | 7 (2.0%) |
Loop diuretic, n (%) | 1248 (19.5%) | 274 (12.0%) | 974 (23.7%) | 397 (14.2%) | 687 (21.2%) | 164 (46.2%) |
MRA, n (%) | 339 (5.3%) | 96 (4.2%) | 243 (5.9%) | 104 (3.7%) | 186 (5.7%) | 49 (13.8%) |
K+ sparing diuretic, n (%) | 507 (7.9%) | 155 (6.8%) | 352 (8.6%) | 193 (6.9%) | 259 (8.0%) | 55 (15.5%) |
Thiazide diuretic, n (%) | 2547 (39.9%) | 872 (38.2%) | 1675 (40.8%) | 1149 (41.1%) | 1262 (39.0%) | 136 (38.3%) |
Digoxin, n (%) | 143 (2.2%) | 31 (1.4%) | 112 (2.7%) | 50 (1.8%) | 75 (2.3%) | 18 (5.1%) |
Statin, n (%) | 5236 (82.0%) | 1775 (77.7%) | 3461 (84.3%) | 2225 (79.5%) | 2695 (83.3%) | 316 (89.0%) |
Nitrate, n (%) | 539 (8.4%) | 103 (4.5%) | 436 (10.6%) | 128 (4.6%) | 307 (9.5%) | 104 (29.3%) |
Oral anticoagulant, n (%) | 484 (7.6%) | 107 (4.7%) | 377 (9.2%) | 176 (6.3%) | 244 (7.5%) | 64 (18.0%) |
K+ binding agent, n (%) | 42 (0.7%) | 10 (0.4%) | 32 (0.8%) | 8 (0.3%) | 28 (0.9%) | 6 (1.7%) |
K+ supplement, n (%) | 608 (9.5%) | 153 (6.7%) | 455 (11.1%) | 202 (7.2%) | 328 (10.1%) | 78 (22.0%) |
Cardio-kidney events
SGLT2i initiators with DKD (N = 6389) | Commercial insurance (N = 2284) | Medicare insurance (N = 4105) | Low CV risk (N = 2797) | Moderate CV risk (N = 3237) | High CV risk (N = 355) | |
---|---|---|---|---|---|---|
CV hospitalization | ||||||
Mean (SD) follow-up time in days | 292.3 (328.5) | 336.3 (368.0) | 267.8 (301.5) | 333.0 (376.0) | 266.4 (284.8) | 207.0 (249.7) |
Rate per 1000 PY (95% CI) | 26.0 (21.6, 30.4) | 16.2 (10.7, 21.6) | 32.9 (26.4, 39.4) | 16.5 (11.5, 21.4) | 31.7 (24.6, 38.9) | 79.5 (40.5, 118.4) |
Kidney hospitalization | ||||||
Mean (SD) follow-up time in days | 294.6 (329.8) | 339.1 (369.4) | 269.9 (302.9) | |||
Rate per 1000 PY (95% CI) | 12.0 (9.0, 15.0) | 5.7 (2.5, 8.9) | 16.5 (11.9, 21.0) | |||
AKI hospitalization | ||||||
Mean (SD) follow-up time in days | 293.5 (330.0) | 338.9 (370.6) | 268.3 (302.2) | |||
Rate per 1000 PY (95% CI) | 22.8 (18.7, 26.9) | 12.3 (7.6, 17.0) | 30.2 (24.0, 36.4) | |||
Discontinuation of SGLT2is | ||||||
Discontinuation, n (%) | 3512 (55.0%) | 1024 (44.8%) | 2488 (60.6%) | |||
Mean (SD) time to discontinuation in days | 300.6 (243.9) | 331.4 (282.5) | 287.9 (225.0) | |||
Median [IQR] time to discontinuation in days | 204 [144, 364] | 221 [143, 420] | 195 [145, 348] | |||
Treatment failure | ||||||
Mean (SD) follow-up time in days | 361.49 (365.96) | 347.14 (371.94) | 369.47 (362.39) | |||
Rate per 1000 PY (95% CI) | 510.46 (492.86, 528.07) | 514.21 (484.06, 544.37) | 508.51 (486.82, 530.19) | |||
Reason for treatment failure | ||||||
SGLT2i discontinuation or switch from SGLT2i to another antidiabetic drug class, n (%) | 3053 (63.6%) | |||||
Addition of another antidiabetic class not used in baseline, n (%) | 1495 (31.1%) | |||||
Initiation of insulin, n (%) | 213 (4.4%) | |||||
Two or more reasons for treatment failure, n (%) | 41 (0.9%) |