title: Canagliflozin treatment of Hispanic and non-Hispanic patients with type 2 diabetes in a US managed care setting.
abstract: BACKGROUND
  Hispanic/Latino (H/L) ethnicity is associated with higher prevalence of type 2 diabetes mellitus (T2DM) and more complications and comorbidities. Few studies of antihyperglycemic agents (AHAs) have compared H/L with non-H/L patients. Randomized controlled trials and observational studies have shown canagliflozin (CANA) is effective at lowering hemoglobin A1C (A1C).
  
  
  OBJECTIVE
  To describe characteristics and compare glycemic control between H/L and non-H/L patients with T2DM filling their first prescription for CANA.
  
  
  METHODS
  This retrospective cohort study examined healthcare claims for diabetic patients who filled ≥1 prescription for CANA between 1 April 2013 and 31 October 2013. We captured available demographic data; ethnicity was imputed as previously published. Clinical data included the Diabetes Complications Severity Index (DCSI), A1C values, and claims for any AHA, with 6 months of follow-up.
  
  
  RESULTS
  Our sample included 438 (11.4%) H/L individuals and 3408 (88.6%) non-H/L individuals; each cohort had 43% females. The H/L patients were younger (53 vs. 56 years, p < 0.001) with higher mean baseline A1C (8.9% vs. 8.5%, respectively; p = 0.028) compared to non-H/L patients. Mean DCSI was similar (H/L 0.92 vs. non-H/L 0.84, p = 0.289) between cohorts. More H/L patients (25%) were taking ≥3 AHAs at the first CANA prescription fill (vs. 21% for non-H/L; p = 0.044), most commonly metformin, followed by sulfonylureas, dipeptidyl peptidase-4 inhibitors, and basal insulin. Among patients with ≥2 fills for CANA, mean adherence (proportion of days covered) was slightly lower for H/L than non-H/L patients (0.77 vs. 0.80, p = 0.003). From their respective baseline A1C values, reduction in A1C was significantly greater for H/L than non-H/L patients (1.1% vs. 0.8%; p = 0.043).
  
  
  CONCLUSIONS
  Compared with non-H/L patients, our H/L patients were younger and had higher mean baseline A1C. Significant improvement in glycemic control was observed for both cohorts, with greater improvement for H/L patients. Additional research is warranted, including longer follow-up and adjusting for possible confounding factors.
authors.affiliation: a a Health Economics & Outcomes Research, Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Wing
authors.initials: W
authors.lastname: Chow
authors.affiliation: b b Health Economics and Outcomes Research , Optum, Eden Prairie, MN , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Buysman
authors.affiliation: a a Health Economics & Outcomes Research, Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Marcia F T
authors.initials: MF
authors.lastname: Rupnow
authors.affiliation: c c Seville Medical Center, Huntington Park , CA , USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Aguilar
authors.affiliation: b b Health Economics and Outcomes Research , Optum, Eden Prairie, MN , USA.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Henk
mesh_terms: D000328:Adult; D000068896:Canagliflozin / Q000627:therapeutic use*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000068896:Canagliflozin; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Canagliflozin; Hemoglobin A1C; Hispanic; Latino; Type 2 diabetes