Quality goal attainment and maintenance in patients with type II diabetes mellitus initiated on canagliflozin or a glucagon-like peptide-1 receptor agonist in an actual practice setting

Objective: To compare achievement of quality goals (HbA1c, weight loss/body mass index [BMI], systolic blood pressure [SBP]), including maintaining HbAlc, between patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin 300 mg (CANA) or a GLP-1 in an actual practice setting. Methods: Adults with T2DM newly initiated on CANA or a GLP-1 were identified from the IQVIA((TM)) Real-World Data Electronic Medical Records-US database (2012Q2-2G16Q1}. To account for differences in baseline characteristics, inverse probability of treatment weighting was used. Outcomes were compared using Cox models (hazard ratios [HRs] and 95% confidence intervals [CIs]) and Kaplan-Meier analyses. Results: CANA (n = 11,435) and GLP-1 (n=11,582) cohorts had similar attainment of HbAlc < 8.0% (64mmol/mol) and HbAlc < 9.0% (75mmol/mol; HbAlc < 8.0%: HR [CI]=0.98 [0.91-1.06]; HbAlc < 9.0%: HR [CI] = 1.02 [0.93-1.12]), while GLP-1 patients were 10% more likely to achieve HbA1c < 7.0% (53 mmol/ mol). CANA and GLP-1 patients were similar in maintaining HbAlc < 7.0%,< 8.0%, or < 9.0%, achieving weight loss >= 5%(HR [CI] = 1.05 [0.99-1.12]), achieving BMI < 30kg/m(2) (HR [CI] = 1.11 [0.98-1.27]), and achieving SBP < 140mmHg (HR [CI] = 1.07 [0.98-1.17]). CANA patients were 30% less likely to discontinue treatment, 28% less likely to have a prescription for a new anti-hyperglycemic, and 17-21% less likely to fail to maintain HbAlc < 8.0% or 9.0% or have a prescription for a new anti-hyperglycemic (composite outcome) vs GLP-1. No significant difference was observed for the composite outcome using the HbAlc < 7.0% threshold. Conclusions: This retrospective study in an actual practice setting showed that CANA patients were generally as likely as GLP-1 patients to achieve HbAlc, weight, and blood pressure thresholds, and to maintain glycemic control while being less likely to discontinue treatment and/or have a new anti-hyperglycemic prescribed.