High-risk T2D: canagliflozin delays need for insulin initiation in CANVAS

  • Matthews DR & al.
  • Diabetes Obes Metab
  • 20 Jul 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Canagliflozin delayed the time to insulin therapy and the need for initiation of other antihyperglycaemic agents (AHAs) compared with placebo over a 5-year period in patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD) in the CANagliflozin cardioVascular Assessment Study (CANVAS) Program.

Why this matters

  • Lower use of insulin and other AHAs associated with canagliflozin may represent reduced utilisation of health services, reduced healthcare costs, better adherence and improved patient satisfaction.

Study design

  • Post hoc analysis of CANVAS Program: 2 randomised controlled trials among 10,142 patients with T2D and high CVD risk.
  • Randomisation: canagliflozin vs placebo.
  • Main outcome: initiation of insulin and other AHAs.
  • Funding: Janssen Research & Development, LLC.

Key results

  • At 1 year, fewer participants in the canagliflozin vs placebo group initiated any AHA (7% vs 16%), insulin (3% vs 9%) or any non-insulin AHA (5% vs 12%; P<.001 for all>
  • Overall AHA initiation increased over time but was consistently lower with canagliflozin vs placebo:
    • At 3 years (any AHA: 19% vs 32%; insulin: 9% vs 21%; or non-insulin AHA: 15% vs 26%); and
    • At 5 years (any AHA: 28% vs 43%; insulin: 14% vs 30%; or non-insulin AHA: 23% vs 36%).
  • Patients treated with canagliflozin vs placebo were less likely to initiate:
    • any AHA (HR, 0.47; 95% CI, 0.43-0.51);
    • insulin (HR, 0.37; 95% CI, 0.31-0.43); and
    • any non-insulin AHA (HR, 0.50; 95% CI, 0.45-0.55; P for all <.001>
  • The time difference between 10% of patients in the canagliflozin and placebo groups being initiated on insulin from the beginning of the trial was >2 years.
  • Canagliflozin vs placebo delayed the time for initiation of other AHAs, including metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sulphonylureas (P<.001 for each>


  • Post hoc analysis.