Oral abstracts
Crabtree, T. S. J. Gallagher, A. Gallen, I. Melvin, A. Elliott, J Bickerton, A Dhatariya, K Rayman, G Ryder, R. E. J.
Crabtree, T. S. J.
Gallagher, A.
Gallen, I.
Melvin, A.
Elliott, J
Bickerton, A
Dhatariya, K
Rayman, G
Ryder, R. E. J.
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Affiliation
Sandwell and West Birmingham NHS Trust; University Hospitals of Derby and Burton NHS Trust; University of Nottingham; University Hospitals of Leicester NHS Trust; Royal Berkshire NHS; Bedfordshire Hospitals NHS Trust
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Publication date
2022-03-28
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Abstract
Aim:SGLT2i have recognised benefits in slowing the pro-gression of renal disease and reducing microalbuminuria. Previous analyses from the ABCD audits demonstrated significant changes in urinary albumin creatinine ratios (uACR). This analysis aims to compare this effect across the class. Methods: Datasets were extracted from the ABCD audit. Those with relevant data at baseline and at least one follow- up were included. Absolute and relative change uACR were assessed stratified by drug (Empa- , Dapa- and Canagliflozin) and baseline uACR (normo- , micro- and macroalbuminuria) using Wilcoxon Sign- Rank (within group) and Dunn’s Test (Bonferroni corrected, between groups).Results: 7,104 datasets were included (Empagliflozin = 4,049; Dapagliflozin = 2,239; Canagliflozin = 816) with baseline mean±SD age 61.1±10.2 years, HbA1c 74.5±16.2mmol/mol, weight 97.0±21.3kg, BMI 33.6± 6.6kg/m2, eGFR 80.5±15.3mL/min/1.73m2and median (IQR) diabetes duration 8.8years (5- 13.2) with follow- up over 1.8 years (1.0- 2.8). These were similar across all three drugs.Stratified by baseline uACR, those with microalbuminu-ria (3≤uACR < 30mcg/mmol) had uACR reductions of 1.7mcg/mmol (95% CI 1.5- 1.9, p < 0.001) and those with macroalbuminuria (uACR≥30mcg/mmol) had 31.6mcg/mmol reductions (95% CI 27.1- 35.4, p < 0.001). No change was noted in the normoalbuminuric group. Differences between groups were significant (p < 0.0001). Relative reductions in uACR were greatest in the macroalbuminu-ria group (55%, 95% CI 49- 61%, p < 0.001). Dapagliflozin appeared to be marginally inferior to Canagliflozin and Empagliflozin (p < 0.001 for both), particularly in the macroalbuminuric individuals with an attenuated fall in uACR of 16.3mcg/mmol (95% CI 4.8- 29), significantly less than the average for this group.Conclusion: SGLT2i are associated with reductions in uACR at follow- up. These reductions are greatest in those with macroalbuminuria at baseline. Dapagliflozin ap-peared to be slightly inferior in those with baseline mac-roalbuminuria. Reasons for this are unclear and may be due to confounding factors.Acknowledgement: ABCD SGLT2 audit contributorsA42 (P219)
Citation
T. S. J. Crabtree, A. Gallagher, I. Gallen, A. Melvin, J. Elliott, A. Bickerton, K. Dhatariya, G. Rayman, R. E. J. Ryder. The effect of sodium-glucose link transporter 2 inhibitors (SGLT2i) on microalbuminuria: Cross-class analysis from the ABCD audit programme. A41 (P230). Diabetic Medicine.2022 (39). https://doi.org/10.1111/dme.14809.
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Article