Glycemic Control Outcomes After Canagliflozin Initiation: Observations in a Medicare and Commercial Managed Care Population in Clinical Practice

Purpose: Although the efficacy of canagliflozin has been well established in clinical trials, research regarding its use and impact on outcomes in clinical practice has been limited by the availability of data on observations up to and beyond 6 months after the initial use of canagliflozin. The purpose of this study was to evaluate changes in glycemic control after the initiation of canagliflozin use in a managed care population. Methods: A retrospective cohort analysis in adults with type 2 diabetes mellitus was conducted using medical and pharmacy claims data and laboratory results from the Humana Research Database. The differences between hemoglobin (Hb) A(1c) levels pre- and postindex were assessed. Changes from pre- to postindex in the percentages of patients achieving glycemic control (eg, HbA(1c) <7% or <8%) were evaluated. HbA(1c) levels were also observed during days 31 to 90, 91 to 180, 181 to 270, and 271 to 360 postindex relative to preindex to assess the durability of HbA(1c) change over time. Analyses were conducted in the full cohort and in 3 subgroups: (1) HbA(1c) >= 7% at baseline; (2) age >= 65 years; (3) and Medicare members age >= 65 years and HbA(1c) >= 7% at baseline. Findings: Among the 1562 patients meeting the study criteria, the mean HbA(1c) values pre- and post index were 8.6% and 7.9%, respectively (P < 0.0001); in the subgroup with HbA(1c) >= 7% at baseline, these values were 8.9% and 8.0%; in the subgroup aged >= 65 years, 8.5% and 7.9%; and in the subgroup aged >= 65 years with HbA(1c) 7% at baseline, 8.8% and 8.1% (all subgroups, P < 0.001). The percentages of patients meeting glycemic-control thresholds (HbA(1c) <7%, <8%) were significantly greater at postindex in the full study cohort and in all 3 subgroups (all, P < 0.001). Based on longitudinal HbA(1c) results in the postindex periods, HbA(1c) reduction appeared durable across 12 months. Implications: The findings from this study suggest that treatment with canagliflozin is associated with improved glycemic control, as evidenced by HbA(1c) reduction and glycemic goal attainment. Even though not all patients had valid HbA(1c) measurements available in each quarter during the follow-up period, the reductions in mean HbA(1c) appeared durable across the postindex intervals. The observations from this majority Medicare Advantage with Prescription Drug sample and, more specifically, in the subgroups limited to patients aged >= 65 years are particularly informative for payers and providers managing or caring for patients of this age with diabetes. (C) 2016 Elsevier HS Journals, Inc. All rights reserved.