Scientific Poster Session III - Original Research

Abstract

Angiotensin-converting enzyme inhibitors (ACEis) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) both provide cardiovascular and renal benefits in Type 2 Diabetes (T2D) patients, suggesting advantages from co-administration. However, evidence on ACEi usage patterns among SGLT2i users is limited.

Research Question or Hypothesis:

To examine ACEi prevalence and discontinuation in SGLT2is initiators and to identify important factors associated with ACEi discontinuation in T2D patients.

Study Design:

A retrospective cohort study.

Methods:

Using 2012-2021 Medicare data, we included T2D patients who newly initiated SGLT2is between 04/01/2013 and 12/31/2018. We identified individuals who filled =1 ACEi prescription(s) at the time of or after SGLT2i initiation. Patients were followed from the index date (first ACEi prescription date filled after SGLT2i initiation) for 12 months and censored at death, disenrollment, one year after the index date, or end of the study (12/31/2020). ACEi discontinuation was defined as a treatment gap of 60 days. Multivariate logistic regressions were constructed to identify factors associated with ACEi discontinuation among a comprehensive list of demographics, clinical characteristics, and medication use.

Results:

Among 9,717 SGLT2i initiators, 4,798 were active ACEi users at the time of SGLT2 initiation, and 1,221 of these patients (25.45%) discontinued their ACEi within 12 months of SGLT2 initiation. Compared to White patients, Black patients [adjusted odds ratio (aOR) = 1.71, 95% confidence interval (CI): 1.34-1.97] had higher odds of discontinuing ACEi. Patients using angiotensin receptor blockers (aOR = 1.56, 95% CI: 1.21-2.01) and those with a history of stroke (aOR = 1.27, 95% CI:1.04-1.56) were more likely to discontinue ACEi, while patients on metformin (aOR = 0.70, 95% CI: 0.60-0.81) and diuretic (aOR = 0.81, 95% CI: 0.68-0.96) had lower odds of discontinuation.

Conclusion:

Approximately one-quarter of the ACEi users discontinued their therapy after SGLT2i initiation. Patient demographics, comorbidities, and medication use were associated with ACEi discontinuation in T2D patients initiating SGLT2is.

Presenting Author

Authors