Characteristics of Alberta adults with diabetes and chronic kidney disease, stratified by use of sodium–glucose cotransporter 2 inhibitors
| Variable | No. (%)* | p value | ||
|---|---|---|---|---|
| Diabetes + chronic kidney disease n = 76 630 | No SGLT2 inhibitor use n = 71 170 | SGLT2 inhibitor use n = 5460 | ||
| Sociodemographic characteristics | ||||
| Age, yr, mean ± SD | 74 ± 12 | 74 ± 13 | 68 ± 9 | < 0.001 |
| Sex, female | 35 932 (46.9) | 34 085 (47.9) | 1847 (33.8) | < 0.001 |
| Residence, rural† | 10 961 (14.3) | 10 217 (14.4) | 744 (13.6) | 0.1 |
| Neighbourhood income quintile | n = 74 649 | n = 69 369 | n = 5280 | |
| 1 (lowest) | 18 721 (25.1) | 17 485 (25.2) | 1236 (23.4) | 0.02 |
| 2 | 16 678 (22.3) | 15 510 (22.4) | 1168 (22.1) | |
| 3 | 14 733 (19.7) | 13 669 (19.7) | 1064 (20.2) | |
| 4 | 13 425 (18.0) | 12 416 (17.9) | 1009 (19.1) | |
| 5 (highest) | 11 092 (14.9) | 10 289 (14.8) | 803 (15.2) | |
| Renal function | ||||
| Serum creatinine, μmol/L, mean ± SD | 108 ± 28 | 108 ± 29 | 105 ± 25 | < 0.001 |
| eGFR (CKD-EPI), mean ± SD | 55 ± 16 | 55 ± 16 | 61 ± 15 | < 0.001 |
| Chronic kidney disease stage by eGFR‡ | ||||
| None or stage 1 | 0 (0) | 0 (0) | 0 (0) | < 0.001 |
| Stage 2 | 29 085 (38.0) | 26 133 (36.7) | 2952 (54.1) | < 0.001 |
| Stage 3 | 46 297 (60.4) | 43 805 (61.5) | 2492 (45.6) | |
| Stage 4 | 1248 (1.6) | 1232 (1.7) | 16 (0.3) | |
| Proteinuria | ||||
| None or mild | 32 305 (42.2) | 30 759 (43.2) | 1546 (28.3) | < 0.001 |
| Moderate | 31 458 (41.1) | 28 532 (40.1) | 2926 (53.6) | |
| Severe | 12 038 (15.7) | 11 144 (15.7) | 894 (16.4) | |
| Nephrotic | 829 (1.1) | 735 (1.0) | 94 (1.7) | |
| Angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker, current use | ||||
| Yes | 47 264 (61.7) | 42 604 (60.0) | 4660 (85.3) | < 0.001 |
| Diabetes | ||||
| HbA1c, %, mean ± SD | 7.2 ± 1.5 | 7.1 ± 1.5 | 1.5 ± 8.1 | < 0.001 |
| HbA1c, % | n = 64 477 | n = 59 017 | ||
| ≤ 7.0 | 36 425 (56.5) | 35 263 (59.8) | 1162 (21.3) | < 0.001 |
| 7.1–9.0 | 21 353 (33.1) | 18 152 (30.8) | 3201 (58.6) | |
| > 9.0 | 6699 (10.4) | 5602 (9.5) | 1097 (20.1) | |
| HbA1c missing | 12 153 (–) | 12 153 (–) | 0 (–) | – |
| Insulin intensity | ||||
| None | 60 365 (78.8) | 57 477 (80.8) | 2888 (52.9) | < 0.001 |
| Basal only | 7028 (9.2) | 5708 (8.0) | 1320 (24.2) | |
| Bolus ± basal | 9237 (12.1) | 7985 (11.2) | 1252 (22.9) | |
| Comorbidities | ||||
| Coronary artery disease | 25 896 (33.8) | 23 822 (33.5) | 2074 (38.0) | < 0.001 |
| Stroke§ | 15 006 (19.6) | 14 153 (19.9) | 853 (15.6) | < 0.001 |
| Heart failure | 15 127 (19.7) | 14 327 (20.1) | 800 (14.7) | < 0.001 |
| Elixhauser Comorbidity Index, mean ± SD | 16 ± 11 | 16 ± 11 | 13 ± 10 | < 0.001 |
| Health care utilization | ||||
| Family physician, no. of visits, mean ± SD | 6.9 ± 7.5 | 6.8 ± 7.6 | 7.2 ± 5.4 | 0.001 |
| Family physician visits, ≥ 1 | 68 675 (89.6) | 63 335 (89.0) | 5340 (987) | < 0.001 |
| Family physician visits, frequency, visits | ||||
| 0 | 7955 (10.4) | 7835 (11.0) | 120 (2.2) | < 0.001 |
| 1–4 | 25 728 (33.6) | 23 990 (33.7) | 1738 (31.8) | |
| > 4 | 42 947 (56.0) | 39 345 (55.3) | 3602 (66.0) | |
| Internal medicine physician, no. of visits, mean ± SD | 0.5 ± 1.3 | 0.4 ± 1.3 | 0.8 ± 1.6 | < 0.001 |
| Internal medicine physician visits, ≥ 1 | 16 415 (21.4) | 14 608 (20.5) | 1807 (33.1) | < 0.001 |
| Cardiologist, no. of visits, mean ± SD | 0.2 ± 0.7 | 0.2 ± 0.7 | 0.3 ± 0.8 | < 0.001 |
| Cardiologist visits, ≥ 1 | 8976 (11.7) | 8137 (11.4) | 839 (15.4) | < 0.001 |
| Endocrinologist, no. of visits, mean ± SD | 0 ± 0.3 | 0 ± 0.3 | 0.1 ± 0.7 | < 0.001 |
| Endocrinologist visits, ≥ 1 | 1158 (1.5) | 858 (1.2) | 300 (5.5) | < 0.001 |
| Nephrologist, no. of visits, mean ± SD | 0.1 ± 0.5 | 0.1 ± 0.5 | 0.1 ± 0.5 | 0.06 |
| Nephrologist visits, ≥ 1 | 6219 (8.1) | 5831 (8.2) | 388 (7.1) | < 0.001 |
| Hospitalization, ≥ 1 | 11 654 (15.2) | 11 018 (15.5) | 636 (11.6) | < 0.001 |
Note: CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration, eGFR = estimated glomerular filtration rate, HbA1c = hemoglobin A1c, KDIGO = Kidney Disease: Improving Global Outcomes, SD = standard deviation, SGLT2 = sodium–glucose cotransporter 2.
↵* Unless stated otherwise.
↵† Rural residence determined by postal code linkage to Statistics Canada population centres or rural area classification. Rural areas defined by Statistics Canada as having a population less than 1000 or a population density of < 400 people per square kilometre. Owing to imprecision in postal code mapping, in some instances, mode of mail delivery may proxy for rural residence.
↵‡ Chronic kidney disease stage definitions: none or stage 1 (eGFR ≥ 90), stage 2 (eGFR 60–89), stage 3 (eGFR 30–59), stage 4 (eGFR 15–29), with eGFR determined from serum creatinine measurements using CKD-EPI equations.
↵§ Stroke: includes hemorrhagic as well as ischemic intracerebral events (e.g., subarachnoid hemorrhage, ischemic stroke).