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Loop diuretic use among patients with heart failure and type 2 diabetes treated with sodium glucose cotransporter-2
Erin R Weeda1, Christy Cassarly2, Daniel L Brinton3
1Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA.
Aims:
To compare loop diuretic use in patients with comorbid heart failure (HF) and type 2 diabetes (T2D) newly initiated on sodium glucose cotransporter-2 inhibitors (SGLT2Is) versus other oral anti-glycemic agents (AGAs).
Methods:
This analysis used 2013-2015 MarketScan Medicare Supplemental claims data. HF and T2D patients were identified and SGLT2I users were propensity score matched to other AGA users. The mean daily dose of loop diuretics in furosemide equivalents was ascertained. For those not on baseline loop diuretics, new use was compared between cohorts. For those on baseline loop diuretics, we assessed patterns of use (increased dose, decreased dose, stable dose, no longer using) at 12-months.
Results:
A total of 750 SGLT2I users were matched to 750 other AGA users. The distribution of loop diuretic use at mean doses of 0 mg (i.e., no use), ≤20 mg, >20 mg-40 mg, >40 mg-80 mg and >80 mg/day did not differ between cohorts at baseline or 12-months (p > 0.05 for both). SGLT2I use was associated with less new loop diuretic use (22.7% [79/348] vs. 34.0% [132/388]; p = 0.001). For those on loop diuretics at baseline (n = 764), patterns of use at 12-months did not differ between cohorts (p = 0.14).
Conclusions:
New loop diuretic use was less frequent among SGLT2I users; however, patterns of loop diuretic use did not differ between cohorts in those on loop diuretics at baseline.
Insights
Sodium glucose cotransporter-2 inhibitors (SGLT2Is) were associated with less new loop diuretic use in patients with heart failure and type 2 diabetes. However, existing loop diuretic use patterns remained similar between SGLT2I and other anti-glycemic agent users.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Comorbidities of heart failure (HF) and type 2 diabetes (T2D) are common.
- Sodium glucose cotransporter-2 inhibitors (SGLT2Is) are increasingly used for T2D management and have shown cardiovascular benefits.
- Loop diuretic use is common in HF patients and can be influenced by glycemic control strategies.
Purpose of the Study:
- To compare loop diuretic utilization in patients with comorbid HF and T2D initiating SGLT2 inhibitors versus other oral anti-glycemic agents (AGAs).
- To assess new loop diuretic initiation and patterns of use in these patient cohorts.
Main Methods:
- Analysis of 2013-2015 MarketScan Medicare Supplemental claims data.
- Propensity score matching of SGLT2I users to other AGA users with comorbid HF and T2D.
- Comparison of mean daily loop diuretic doses (furosemide equivalents) and patterns of use at 12 months.
Main Results:
- 750 SGLT2I users were matched to 750 other AGA users.
- SGLT2I use was associated with significantly less new loop diuretic use (22.7% vs. 34.0%, p=0.001).
- Among patients already on loop diuretics at baseline, patterns of use (dose changes, discontinuation) did not differ between SGLT2I and other AGA users at 12 months (p=0.14).
Conclusions:
- New loop diuretic initiation is less frequent in patients with HF and T2D treated with SGLT2Is compared to other AGAs.
- Existing loop diuretic use patterns are not significantly different between SGLT2I and other AGA users in this population.
- SGLT2Is may influence diuretic management strategies in patients with comorbid HF and T2D.
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