Canagliflozin Reduces Hospitalization Rates in Patients with Type 2 Diabetes

Although sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce cardiovascular and renal events, as well as hospitalizations in patients with type 2 diabetes (T2D), there is limited data on the causes of hospitalizations resulting from SGLT2i use.

A recent study investigated the reasons for hospitalizations, as well as rates of hospitalizations in participants of the Canagliflozin Cardiovascular Assessment Study (CANVAS) assigned canagliflozin in comparison to placebo.

Investigators, led by Kent Y. Feng, MD, Stanford Center for Clinical Research, Stanford University School of Medicine, observed the most common cause for hospitalizations in patients with T2D included cardiac disorders, infections and infestations, and nervous system disorders, while canagliflozin reduced the rate of total all-cause hospitalization (ACH).

Study

The team performed a secondary analysis of the CANVAS, which evaluated the safety and efficacy of canagliflozin versus placebo through 2 large randomized controlled trials (RCTs).

The study’s primary prevention cohort comprised participants ≥50 years old with ≥2 risk factors for cardiovascular events, but no prior cardiovascular event. In addition, the secondary prevention cohort was participants ≥30 years old with prior cardiovascular events.

After a placebo run-in period, participants were randomized 1:1:1 to receive cangliflozin 100 mg daily, canagliflozin 300 mg daily, or placebo.

Primary outcome for the analysis included the rate of total ACH, with hospitalization data collected from adverse event reporting.

On the other hand, secondary outcomes included total hospitalizations categorized by the Medical Directory for Regulatory Activities hierarchy at the system organ class level. These outcomes were assessed through negative binomial models.

Results

A total of 10,142 participants were enrolled in CANVAS with 5795 patients randomized to canagliflozin and 4347 patients to placebo.

In addition, 3486 patients (34.4%) were hospitalized, with hospitalized patients more likely to be older (64.5 years versus 62.7 years), male (69% versus 62%), have microvascular complications (60% versus 43%), and a longer duration of diabetes (14.6 versus 13.0 years).

Further, a total of 7115 ACH were observed. Most commonly, hospitalizations in the cohort were a result of cardiac disorders (23.7%), infections and infestations (15.0%), and nervous system disorders (9.0%).

After calculation for the rate of total ACH, investigators observed patients in the canagliflozin group had a lower rate of total ACH compared to placebo.

Data show 197.9 per 1000 patient-years in canagliflozin, in comparison to 215.8 per 1000 patient-years in the placebo group (RR 0.92; 95% CI, 0.86 - 0.98).

In addition, patients in the canaglifozin group had a lower total hospitlization rate due to cardiac disorders compared to placebo, at 48.9 versus 60.0 participants per 1000 patient-years (RR 0.81; 95% CI, 0.75 - 0.88).

They found no significant difference between canagliflozin and placebo groups in total hospitalization rate due to infection and infestation (RR 0.96; 95% CI, 0.86 - 1.02), as well as nervous system disorders (RR 0.96; 95% CI, 0.88 - 1.05).

Conclusion

Investigators concluded the most common factor for hospitalizations of patients with T2D were cardiac disorders, infections and infestations, and nervous system disorders, while canagliflozin reduced the rate of total ACH.

“Reducing the complications from diabetes that result in hospitalizations is a high priority not only from a patient care perspective but also from an economics standpoint, where the costs are rising both for the health care system and the individual patient,” investigators wrote.

The study, “Reasons for hospitalizations in patients with type 2 diabetes mellitus in the CANVAS Program: a secondary analysis,” was published online in Diabetes, Obesity and Metabolism.