Jinnie J Rhee1, Jialin Han2, Maria E Montez-Rath2, Sun H Kim3, Mark R Cullen4, Randall S Stafford5, Wolfgang C Winkelmayer6, Glenn M Chertow7. 1. Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States. Electronic address: rheej@stanford.edu. 2. Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States. 3. Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States. 4. Division of Primary Care and Population health, Stanford University School of Medicine, Stanford, CA, United States. 5. Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States. 6. Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States. 7. Division of Nephrology, Stanford University School of Medicine, Stanford, CA, United States; Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States.
Abstract
AIMS: To quantify patterns of conventional and newer antidiabetic medication use in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHODS: We used data from a large claims and integrated dataset that includes employed and commercially insured patients in the US to select patients who had T2DM and CKD with information on laboratory values and prescriptions for antidiabetic medications from January 1, 2014 to January 1, 2015. We stratified the analyses by sociodemographic variables. RESULTS: In a cohort of 38,577 patients with T2DM and CKD, we found wide variation in the treatment of T2DM by CKD stage as well as by several sociodemographic factors. Although metformin was the most commonly prescribed medication, only about half of patients in the cohort and fewer than two-thirds of patients with early stage CKD were prescribed metformin. Approximately 10.6% of patients with CKD stage 4 and 2.1% of the patients with CKD stage 5 were prescribed metformin. Sulfonylureas with active metabolites that accumulate with impaired kidney function were prescribed in more than one-third of patients with CKD stages 3b, 4, and 5. Only 3.4% and 12.3% of patients were prescribed GLP-1 and DPP-4 respectively. CONCLUSIONS: Prescriptions for metformin were lower than expected among patients with mild to moderate CKD. Prescriptions for newer antidiabetic medications with known safety and efficacy across the spectrum of CKD remained low. Prescriptions for agents contraindicated in advanced CKD continued to be written in a sizeable fraction of patients.
AIMS: To quantify patterns of conventional and newer antidiabetic medication use in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHODS: We used data from a large claims and integrated dataset that includes employed and commercially insured patients in the US to select patients who had T2DM and CKD with information on laboratory values and prescriptions for antidiabetic medications from January 1, 2014 to January 1, 2015. We stratified the analyses by sociodemographic variables. RESULTS: In a cohort of 38,577 patients with T2DM and CKD, we found wide variation in the treatment of T2DM by CKD stage as well as by several sociodemographic factors. Although metformin was the most commonly prescribed medication, only about half of patients in the cohort and fewer than two-thirds of patients with early stage CKD were prescribed metformin. Approximately 10.6% of patients with CKD stage 4 and 2.1% of the patients with CKD stage 5 were prescribed metformin. Sulfonylureas with active metabolites that accumulate with impaired kidney function were prescribed in more than one-third of patients with CKD stages 3b, 4, and 5. Only 3.4% and 12.3% of patients were prescribed GLP-1 and DPP-4 respectively. CONCLUSIONS: Prescriptions for metformin were lower than expected among patients with mild to moderate CKD. Prescriptions for newer antidiabetic medications with known safety and efficacy across the spectrum of CKD remained low. Prescriptions for agents contraindicated in advanced CKD continued to be written in a sizeable fraction of patients.
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