Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Social protection for mobile populations? A global perspective on immigrant social rights

<jats:title>Abstract</jats:title><jats:p>While a growing body of work investigates the social rights of immigrants, there is a notable lack of comparative research on the topic that includes countries in the Global South. In this paper we argue that existing approaches often lack reproducibility, comparability, and adaptability beyond the cases that they focus on. To remedy this shortcoming, we propose a three‐dimensional conceptualization of immigrant social rights that takes into account differences between legal categories of migrants, between types of welfare benefits, and between types of restrictions. Applying this conceptualization, we offer the Immigrant Social Rights Dataset (ImmigSR), a set of quantitative comparative measures of de jure immigrant social rights covering 39 countries in Europe, Latin America, North America, Oceania and Southeast Asia for the years 1980–2018. Our analyses show commonalities as well as differences between world regions. Rights are more inclusive in the Global North than in the Global South. There is however a slight trend towards convergence, with rights retrenchment in the North and expansions in the South. Across all regions, temporary migrant workers and asylum seekers are the groups that are granted the least comprehensive set of rights. Depending on the dimension that is taken into focus, there are however also more nuanced intra‐regional differences. The findings confirm the usefulness of a multi‐dimensional conceptual approach to measuring immigrant social rights in a diverse set of cases.</jats:p&gt

The Migrant Social Protection Data Set (MigSP). Technical Report

The Migrant Social Protection (MigSP) Dataset provides a set of quantitative comparative measures of de jure immigrant welfare rights in regard to unemployment insurance and social assistance benefits in 39 countries in Europe, Latin America, North America, Oceania and Southeast Asia for the years 1980-2018. This Technical Report outlines the conceptualization and operationalization of immigrant welfare rights, details the data collection and presents the codebook for the data. MigSP builds on data that was collected within the remit of the Immigration Policies in Comparison (IMPIC) project (Helbling et al., 2017; Römer, 2017).Deutsche Forschungsgemeinschaft (DFG)1