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SGLT2i use among Patients with CKD and Diabetes

SGLT2i use among Patients with CKD and Diabetes

In 2020, sodium-glucose cotransporter 2 inhibitor (SGLT2i) use was higher among adults with diabetes in early stages of chronic kidney disease (CKD) (stage 1: 18.2%, stage 2: 18.4%) than those in more advanced stages of CKD (stage 3: 15.5%, stage 4: 6.6%, and stage 5: 6.4%).

Data Source: Clinformatics Commercial
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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.

FieldData
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.

SGLT2i 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.

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.