Aim To better understand the healthcare burden of people with type 2 diabetes (T2D) and estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 in Ontario, Canada. Materials and Methods We used administrative data to evaluate the prevalence of T2D, eGFR < 90 mL/min/1.73 m2 and adverse cardiovascular co‐morbidities in individuals aged ≥ 30 years living in Ontario, Canada. We also examined incremental healthcare costs and healthcare resource utilization (HCRU) for these patients with specific incident cardiovascular and renal outcomes, in comparison with controls without these outcomes. Results While the prevalence of T2D in the general population aged ≥ 30 years in Ontario increased by 1.8% over a 5‐year period (2011‐2012 to 2015‐2016), the prevalence of eGFR < 90 mL/min/1.73 m2 among people with T2D increased by 35%. In comparison with corresponding controls without these outcomes, the per patient average total costs (Canadian dollars) over a 2‐year analysis period were higher for patients with cardiovascular disease/chronic kidney disease related death ($69 827; n = 32 407), doubling of serum creatinine ($52 260; n = 22 825), those who started dialysis ($150 627; n = 3499) or received a kidney transplant ($50 664; n = 651). Similarly, HCRU was significantly greater for patients with these incident outcomes. Conclusions This real‐world retrospective study highlights an increasing prevalence of T2D, eGFR < 90 mL/min/1.73 m2, and the substantially higher healthcare costs and HCRU when these patients have adverse cardiovascular and renal outcomes. The existence of such a large economic burden underpins the importance of preventing these diabetes‐related complications.
Background and Aims The CREDENCE trial with canagliflozin demonstrated definitive evidence of renal benefits to slow the progression of end stage renal disease (ESRD) in type 2 diabetes (T2D) patients with chronic kidney disease (CKD). This real-world study was undertaken to better understand the prevalence of CKD among T2D patients in Ontario using the CREDENCE trial criteria. Ontario is the largest province, accounting for 38.8% of Canada’s population in 20191. Patients were identified in the following cohorts: T2D-CKD, T2D-CKD+cardiovascular disease (CVD), T2D-CKD+stroke, and T2D-CKD+CVD or stroke. Method This population-based retrospective cohort study was conducted in partnership with IQVIA and the Institute for Clinical Evaluative Sciences (ICES). The ICES data repository contains publicly funded administrative health service records for the Ontario population eligible for universal health coverage since 1986. Patients’ eligibility for this study was aligned with enrolment criteria in the CREDENCE trial. Patients were ≥30 years of age at index and were identified as having both T2D and CKD. Diabetes patients were identified using the validated Ontario Diabetes Database (ODD), patients <19 years of age when first diagnosed with diabetes were excluded due to suspected type 1 diabetes (T1D). Additionally, patients with a T1D diagnosis at any time-point were excluded. CKD patients were identified through diagnosis/billing codes or estimated glomerular filtration rate(eGFR)<90 ml/min/1.73ml2 derived from serum creatinine laboratory values. Diagnosis/billing codes are expected to have poor sensitivity2,3 when used as the sole method to identify CKD. To account for anticipated missing information in each dataset, the capture-recapture method was used to obtain a more accurate estimate for the total prevalence. Capture-recapture accounts for incomplete ascertainment of administrative datasets by using the overlap between the datasets to derive an estimate of the total population4,5 (Figure 1). This method was used in Manitoba to estimate the total CKD population, using administrative and laboratory datasets4. Therefore, each cohort (T2D-CKD, T2D-CKD+CVD, T2D-CKD+stroke, and T2D-CKD+CVD or stroke) has utilized each of the following four methods to identify CKD patients: diagnosis/billing codes, eGFR, diagnosis/billing codes or eGFR, and capture-recapture method. Yearly point prevalence of CKD among T2D patients is reported for the five fiscal years (FY) between 2011/12 and 2015/16. Results The prevalence of T2D patients ≥30 years of age in Ontario has increased from 959,850 in FY2011/12 to 1,169,759 in FY2015/16 (Figure 2). The prevalence of CKD among T2D patients ≥30 years of age in Ontario has increased across all methods from FY2011/12 to FY2015/16: from 21% to 28% based on diagnosis/billing codes, 47% to 63% based on eGFR, 55% to 70% based on diagnosis/billing codes or eGFR, and 76% to 84% based on capture-recapture. Similarly, prevalence of T2D-CKD+CVD, T2D-CKD+stroke, and T2D-CKD+CVD or stroke has increased in most cases (Figure 3). Conclusion CKD is a common comorbidity amongst T2D patients ≥30 years of age. The study provides estimates of the prevalence of CKD in four cohorts of T2D patients with defined co-morbidities and shows that the use of diagnosis/billing codes alone may underestimate the prevalence of CKD in T2D patients. Furthermore, this real-world analysis highlights a significant, increasing prevalence of CKD among T2D patients ≥30 years of age in Ontario with all methods. On-going research aims to assess the burden of illness of patients with both T2D and CKD who are incident to T2D-related outcomes (CKD or CVD related death, kidney transplant, kidney dialysis, doubling of serum creatinine).
Background: Though oral antidepressants can be effective at reducing depressive symptoms, they can take 4–6 weeks to reach full effect. Limitations relating to slow onset of action and resistance to current treatments for patients with major depressive disorder (MDD), particularly for MDD in a psychiatric emergency such as major depressive disorder with acute suicidal ideation or behavior (MDSI), is an issue across all countries and healthcare settings. Due to the current unmet needs and slow onset of action from oral antidepressants, patients with MDSI need interventions that provide a rapid relief of depressive symptoms. This study aimed to identify unmet needs in the treatment for MDSI, specifically exploring the potential clinical benefits of a rapid reduction of depressive symptoms, associated with treatment with rapid acting antidepressant such as esketamine nasal spray. Methods: A Delphi panel consisting of independent psychiatrists experienced in treating patients with MDSI (n=12) from the United States, Canada, United Kingdom, and European Union, was conducted between December 2020–June 2021. Psychiatrists were recruited and screened by an independent party to ensure that they had the required experience. Psychiatrists completed two rounds of anonymized questionnaires, and a virtual consensus meeting to collect their perceptive on current treatments for MDSI. Results: This research confirmed current unmet needs in the treatment of patients with MDSI. Hopelessness, functional impairment, worsening of symptoms, recurrent hospitalization and higher risk of suicide attempt were considered key consequences of the slow onset of action of oral antidepressants. Psychiatrists anticipated that treatment with rapid-acting antidepressants would provide benefits such as shorter hospital stays, improved patient engagement/compliance, and improved patient outcomes. For long-term benefits, psychiatrists agreed that improved daily functioning and increased trust/confidence in treatment options were key benefits of rapid-acting antidepressants. Conclusions: These findings suggest that the use of rapid-acting antidepressants such as esketamine nasal spray, in a psychiatric emergency, may help alleviate some of the current unmet needs experienced by patients with MDSI. This Delphi panel of psychiatrists highlighted that treatment with rapid-acting antidepressants can provide clinically meaningful benefits in the and long-term, as well as the immediate- and short-term, for patients with MDSI.
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