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Antihyperglycemic treatment patterns for chronic kidney disease and type 2 diabetes
Keith A Betts, Nikolaus G Oberprieler, Aozhou Wu
1Bayer Hispania, Avda Baix Llobregat 3-5, Sant Joan Despí 08970, Barcelona, Spain.
Objective:
Patients with type 2 diabetes (T2D) are at high risk for developing chronic kidney disease (CKD). The onset of incident CKD may complicate glycemic control among these patients. This study aimed to characterize antihyperglycemic medication use after incident CKD onset among patients with T2D to inform disease management.
Study Design:
Retrospective cohort study.
Methods:
Patients with incident CKD and prior T2D were identified from the Optum electronic health records database between March 2013 and September 2021. Patterns of antihyperglycemic use were assessed during the 1-year baseline period and after incident CKD diagnosis and described by baseline hemoglobin A1C (HbA1C) level (controlled [< 7%] vs elevated [≥ 7%]) and CKD severity.
Results:
The study consisted of 262,395 patients, of whom 51% had elevated HbA1C. After CKD onset, 23.9% of patients initiated new antihyperglycemics within 1 year. Patients with elevated HbA1C had shorter time to new treatment initiation compared with those with controlled HbA1C (median, 28.7 vs 83.7 months). Patients with elevated urine albumin-to-creatinine ratio (uACR) had shorter median time to new treatment initiation (39.9-42.4 months) than those with normal uACR (59.8 months). Less than 7% of patients with stage 3 CKD and even smaller percentages of patients with higher stages of CKD utilized glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors.
Conclusions:
Treatment of T2D was considerably heterogenous by HbA1C level and CKD severity in patients with incident CKD. Current agents may not sufficiently fulfill the unmet need of T2D management in patients with CKD.
Insights
Patients with type 2 diabetes and chronic kidney disease show varied medication use. Those with higher HbA1C or kidney damage received treatment faster, but newer drugs were underused in advanced CKD.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Type 2 diabetes (T2D) patients face high risk of chronic kidney disease (CKD).
- CKD onset can complicate glycemic control in T2D patients.
- Understanding antihyperglycemic medication use is crucial for managing T2D with CKD.
Purpose of the Study:
- To characterize antihyperglycemic medication use after incident CKD onset in T2D patients.
- To inform disease management strategies for T2D patients with newly diagnosed CKD.
- To analyze medication patterns based on glycemic control and CKD severity.
Main Methods:
- Retrospective cohort study using electronic health records (March 2013-September 2021).
- Identified T2D patients with incident CKD.
- Assessed antihyperglycemic use during baseline and post-CKD diagnosis, stratified by HbA1C and CKD severity.
Main Results:
- 262,395 patients included; 51% had elevated HbA1C.
- 23.9% initiated new antihyperglycemics within 1 year post-CKD onset.
- Elevated HbA1C and uACR correlated with faster treatment initiation; newer agents (GLP-1 RAs, SGLT2 inhibitors) were underutilized in advanced CKD stages.
Conclusions:
- Antihyperglycemic treatment in T2D patients with incident CKD is heterogeneous.
- Glycemic control (HbA1C) and CKD severity influence medication patterns.
- Current antihyperglycemic agents may not fully address the needs of T2D patients with CKD.
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