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Retrospective Study on the Impact of Adherence in Achieving Glycemic Goals in Type 2 Diabetes Mellitus Patients Receiving Canagliflozin

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Abstract

Introduction

Adherence is poor among patients taking antihyperglycemic agents (AHAs) for type 2 diabetes mellitus (T2DM). Inadequate adherence has been linked to decreased glycemic control and increased healthcare costs and hospitalizations. We examined the impact of real-world adherence on glycemic control in T2DM patients treated with canagliflozin.

Methods

This retrospective study used US administrative claims data from commercial and Medicare Advantage healthcare enrollees. Study subjects were adult T2DM patients with baseline HbA1c ≥7.0% and a pharmacy claim for canagliflozin between April 01, 2013 and August 31, 2014. Outcomes included treatment patterns, HbA1c reductions and goal attainment, pharmacy costs, and patient characteristics. Adherence, measured by the proportion of days covered (PDC), was calculated as the number of days of canagliflozin availability divided by the length of the follow-up period. Results were analyzed overall and compared between patients who were highly adherent (HA) (PDC ≥0.8) versus less than highly adherent (LHA) (PDC <0.8).

Results

The study population included 2261 patients. At the end of follow-up, patients had an overall mean reduction in HbA1c of 0.97%. Those HA had larger reductions in HbA1c than those LHA (1.17% versus 0.73%, respectively, p < 0.001); 24.6% and 59.4% of patients achieved HbA1c goals of <7.0% and <8.0%, respectively. Highly adherent patients were more likely to achieve goals than those LHA. Less than highly adherent patients increased insulin use by 5.4% in the follow-up period, while HA patients decreased the use of most oral AHAs and had no change in insulin use.

Conclusions

Patients had an HbA1c reduction of 0.97% in the 12 months following the first canagliflozin fill. Highly adherent patients achieved a greater reduction in HbA1c at the end of the follow-up period and were more likely to reach HbA1c goals. Highly adherent patients also had reductions in the use of most oral AHAs, while LHA patients saw a small increase in insulin use.

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Acknowledgements

Sponsorship and article processing charges for this study were funded by Janssen Scientific Affairs, LLC, a Johnson and Johnson Company. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Deja Scott-Shemon (Optum) provided medical writing support for this manuscript, which was funded by Janssen Scientific Affairs, LLC.

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Erin K. Buysman is an employee of Optum, which was contracted by Janssen Scientific Affairs, LLC. Amy Anderson is an employee of Optum, which was contracted by Janssen Scientific Affairs, LLC. Shaffeeulah Bacchus is an employee of Janssen Scientific Affairs, LLC. Mike Ingham is an employee of Janssen Scientific Affairs, LLC.

Compliance with Ethics Guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors, nor does it contain identifiable protected health information; thus, it did not require institutional review board approval or waiver of authorization.

Data Availability

The data contained in our database contains proprietary elements owned by Optum and, therefore, cannot be broadly disclosed or made publicly available at this time. The disclosure of this data to third party clients assumes certain data security and privacy protocols are in place and that the third party client has executed our standard license agreement which includes restrictive covenants governing the use of the data.

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Authors and Affiliations

  1. Optum, 11000 Optum Circle, Eden Prairie, MN, 55344, USA

    Erin K. Buysman & Amy Anderson

  2. Janssen Scientific Affairs, LLC, 1000 U.S. Route 202 S, Raritan, NJ, 08869, USA

    Shaffeeulah Bacchus & Mike Ingham

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  1. Erin K. Buysman
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Correspondence to Erin K. Buysman.

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Buysman, E.K., Anderson, A., Bacchus, S. et al. Retrospective Study on the Impact of Adherence in Achieving Glycemic Goals in Type 2 Diabetes Mellitus Patients Receiving Canagliflozin. Adv Ther 34, 937–953 (2017). https://doi.org/10.1007/s12325-017-0500-4

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