Kidney Week

Abstract: TH-PO738

Impact of Gender on the Pattern of Glucose-Lowering Treatment and Hypoglycaemia in Patients with Type 2 Diabetes and Advanced CKD: The French CKD-REIN Study

Session Information

• Diabetic and Obesity Induced Kidney Disease - Clinical - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Diabetes

• 502 Diabetes Mellitus and Obesity: Clinical

Authors

• Metzger, Marie, CESP U1018, INSERM, UPS-UVSQ, Villejuif, France

Marie Metzger,

• Balkau, Beverley, CESP U1018, INSERM, UPS-UVSQ, Villejuif, France

Beverley Balkau,

• Frimat, Luc, Nancy University Hospital, Vandoeuvre les Nancy, France

Luc Frimat,

• Combe, Christian, CHU de Bordeaux, Bordeaux, France

Christian Combe,

• Laville, Maurice, Claude Bernard University Lyon 1, Lyon, France

Maurice Laville,

• Jacquelinet, Christian, Agence de la biomedecine, Saint-Denis La Plaine, France

Christian Jacquelinet,

• Massy, Ziad, CESP U1018, INSERM, UPS-UVSQ, Villejuif, France

Ziad Massy,

• Stengel, Benedicte, CESP U1018, INSERM, UPS-UVSQ, Villejuif, France

Benedicte Stengel,

• Fouque, Denis, Claude Bernard University Lyon 1, Lyon, France

Denis Fouque,

Group or Team Name

• On behalf of CKD Rein and CKDopps investigators

Background

Recommendations for glucose lowering treatments differ according to CKD stage, but not by gender, despite possible differences in efficacy; in consequence, glucose control and hypoglycaemia may differ.

Methods

Of the 3033 patients recruited with CKD stages 3 to 5, 645 men and 288 women were treated by glucose lowering drugs. Uncontrolled glucose was defined by HbA1c ≥ 7%, hypoglycaemia by self-report.

Results

Treatment with insulin (55% men, 65% women) was more frequent in the later stages of CKD (see Figure) with fewer women than men treated with insulin at lower CKD stages, more at higher stages (P_inter=0.008); overall, 31% were treated only with insulin, 28% with combinations: insulin and another drug, 42% by non-insulin glucose lowering drugs. The prevalence of uncontrolled glucose was 57%; in a multivariable model, only insulin treatment, longer diabetes duration and higher BMI were associated with uncontrolled glucose, not gender, age, nor eGFR. Hypoglycaemia were reported by 40% of men and 59% of women; they were not related with eGFR, nor to HbA1c, but were more frequent in people treated with insulin, after adjustment for age, sex, BMI, diabetes duration.

Conclusion

In people with diabetes and CKD, HbA1c, CKD stage and reported hypoglycaemia were not associated. However, glucose–lowering treatment, hypoglycaemia but not glucose control were gender dependent; this seems to be related to insulin treatment which may need to be adapted to avoid hypoglycaemia, especially in women.

Glucose lowering medications by CKD stage and gender

Funding

• Commercial Support –