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Percentage of Patients With CKD and Diabetes Using SGLT2i

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is higher among adults with diabetes in early stages of chronic kidney disease (CKD) (stage 1: 14%, stage 2: 14.2%) than those in more advanced stages of CKD (stage 3: 10.2%, stage 4: 2.9%, and stage 5: 3.8%).

Data Source: Clinformatics Commercial

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SGLT2 Inhibitor Use (%) Among Patients with CKD and Diabetes, by CKD Stage Clinformatics Commercial
CKD Stage	2018	2019	2020
CKD Stage 1	14.4	15.7	18.2
CKD Stage 2	14.4	16.4	18.4
CKD Stage 3	10.4	12.4	15.5
CKD Stage 4	3.3	4.6	6.6
CKD Stage 5	4.0	4.8	6.4
Unmeasured	12.8	11.1	15.5

CKD determined by ICD-9-CM and ICD-10-CM diagnosis codes. Data are not adjusted.

Clinformatics data sets provide paid medical and prescription claims and enrollment information for participants in commercial insurance plans and Medicare Advantage plans. The sample was limited to those enrolled in their health plan for all 12 months of the calendar year. Chronic kidney disease (CKD) and diabetes are defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), or Tenth Revision (ICD-10-CM) diagnosis codes. Outpatient pharmacy records of prescriptions filled for patients were examined for drugs in the sodium-glucose cotransporter-2 (SGLT2) inhibitors class. For inclusion in analyses, beneficiaries had to be in the enrollment file. To define CKD, diabetes, or hypertension, at least one inpatient or two outpatient claims were used.

Field	Data
Description of Measure	The percentage of patients diagnosed with CKD and diabetes that received sodium-glucose cotransporter-2 inhibitor (SGLT2i) drugs.
Data Set	Clinformatics Commercial from Optum Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN).
Population	Privately insured employed patients aged 20–64 years with at least one inpatient or two outpatient claims during the calendar year.
Years Included	2018–2020.
Numerator	Patients aged 20–64 years with prescription for SGLT2i identified by generic name and National Drug Code (NDC).
Denominator	Patients aged 20–64 years enrolled in Clinformatics Commercial insurance and diagnosed with CKD and diabetes.
Definition of CKD	ICD-9-CM and ICD-10-CM diagnosis codes.
ICD-10-CM Codes for CKD	A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4 (x and xx stand for all the codes within the main diagnosis).
ICD-9-CM Codes for CKD	016.0, 095.4, 189.0,189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.xx, 404.xx, 405.01, 405.11, 440.1, 442.1, 447.3, 453.3, 573.4, 580.xx, 581.xx, 582.xx, 583.xx, 584.5, 585.x, 587.xx, 588.xx, 590.xx, 591, 592.x, 593.xx, 642.1, 646.2, 753.xx, 794.4.
SGLT2 drugs	canagliflozin, dapagliflozin, empagliflozin, ertugliflozin.
Diabetes	Diabetes is determined by the presence of an ICD-9-CM code (250.xx, 357.2, 336.41, 362.01, 362.02) or ICD-10-CM (E08.xx, E09.xx, E10.xx, E11.xx, E13.xx) for diabetes on at least one inpatient or outpatient claim during the given calendar year.
Hypertension	Hypertension is determined by the presence of an ICD-9-CM code (401.x through 405.x) or ICD-10-CM code (H35.03x, I10.xx, I11.xx, I12.xx, I13.xx, I15.xxx, I67.4, N26.2) for hypertension on at least one inpatient or outpatient claim during the given calendar year.
Limitations of Indicator	As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will underestimate CKD.
Analytical Considerations	Care must be taken in comparisons based on diagnosis code-based definitions of CKD and diabetes.