Introduction and Objective: SGLT2i have major cardiorenal benefits for people with type 2 diabetes. While some guidelines recommend temporarily withholding SGLT2i during hospitalization, limited evidence suggests many people may not restart SGLT2i following discharge. We examined if hospitalization was a risk factor for SGLT2i discontinuation, and if this differed to other diabetes therapy (DPP-4i) not typically withheld in hospital.Methods: We conducted a retrospective cohort study using linked population level data for all adult residents of New South Wales, Australia. We included adults aged 40+ years initiating either SGLT2i or DPP-4i (separately) between 2016 to 2020 and followed up until the earliest: mid 2021 or death. We defined discontinuation as a period of 90 days without a dispensing. We used Cox proportional hazards models to estimate hazard ratios (HR) for the effect of recent hospitalization (within 90 days of discharge, as a time dependent variable) on discontinuation. Models were adjusted for demographic and clinical characteristics.Results: Of people initiating SGLT2i (n=106,098, median age 63 years, 61% male), 42.6% were hospitalized and 63.1% discontinued SGLT2i during follow-up. Discontinuation rates were higher in periods when people had recently been hospitalized (16.7 per 10,000 person-years) compared to periods with no hospitalization (10.1 per 10,000 person-years). This association remained in adjusted models (HR 1.63; 95% CI 1.59-1.66, p <0.001). Of people initiating DPP-4i (n=91,960, median age 66 years, 57% male), 47.6% were hospitalized, and 64.0% discontinued DPP-4i during follow-up. Discontinuation rates were similarly higher around periods of hospitalization (adjusted HR 1.40, 95% CI 1.37-1.43, p <0.001).Conclusion: Hospitalization is a risk factor for SGLT2i and DPP-4i discontinuation. Given their cardiorenal protection, our data should increase clinician awareness to ensure that SGLT2i and other critical medicines are not discontinued following hospitalization.
T.Y. Milder: None. L. Shepherd: Consultant; AbbVie Inc, IQVIA Inc. S. Pearson: None. H. Råket: None. J. Greenfield: Other Relationship; Novo Nordisk. Speaker’s Bureau; Novartis AG, Amgen Inc, Lilly Diabetes, Boehringer-Ingelheim. R.O. Day: None. J. Lin: None. C.A. Pollock: Speaker’s Bureau; Amgen Inc. Advisory Panel; AstraZeneca. Speaker’s Bureau; AstraZeneca, Boehringer-Ingelheim, CSL Behring. Advisory Panel; CSL Behring, Novo Nordisk A/S. Speaker’s Bureau; Novo Nordisk. B. Neuen: Consultant; AstraZeneca, Alexion Pharmaceuticals, Inc, Bayer Pharmaceuticals, Inc, Boehringer-Ingelheim, Novo Nordisk, Traveere Pharmaceuticals. Research Support; Menarini. M. Jun: Research Support; Boehringer Ingelheim and Eli Lilly Alliance. J. de Oliveira Costa: None. S. Stocker: Research Support; Gilead Sciences, Inc. Consultant; Nutromics Pty Ltd, Bellberry Pty Ltd, Virtus Health Pty Ltd, 23strands Pty Ltd. J. Ludington: None. M.O. Falster: Consultant; IQVIA Inc.
National Health and Medical Research Council Ideas grant (grant number: 2002889); National Health and Medical Research Council Medicines Intelligence Centre of Research Excellence (1196900); National Heart Foundation of Australia Future Leader Fellowship (105609)
Source link
Leave a Reply