Abstract: SA-PO900
Trends in Use of Antidiabetic Drugs Among Diabetic Patients with and Without CKD in the United States (2006-2016)
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
- Gillespie, Brenda W., University of Michigan, Ann Arbor, Michigan, United States
- Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Benoit, Stephen R., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Tuot, Delphine S., University of California, San Francisco, San Francisco, California, United States
- Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco Gen Hosp & UCSF, San Francisco, California, United States
- Herman, William H., University of Michigan, Ann Arbor, Michigan, United States
- Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background
Since 2006, several new antidiabetic drugs have been introduced and shown to be safe in patients with chronic kidney disease (CKD) and metformin’s use among CKD patients has been expanded. How these have changed the prescription of diabetes therapy plans is not clear. Our study compares trends in the use of ten different classes of antidiabetic drugs among diabetic (DM) patients with and without CKD in the US.
Methods
Analysis included 4,281,223 commercially insured members from Optum ClinformaticsTM aged 20-64 years from 2006 to 2016. ICD-CM diagnosis codes were used to identify DM and CKD. Antidiabetic drug use by year was measured as the proportion of patients prescribed the specified medications. OLS model is used to compare changes in antidiabetic therapy between DM patients with and without CKD.
Results
Newer antidiabetic drugs, including SGLT2 inhibitors and two incretin-based therapies (DDP-4 inhibitors and GLP-1 agonists) are increasingly being used for DM patients regardless of kidney function (Fig.1, all p<0.001). There was a notable decline in the use of thiazolidinediones and sulfonylureas in both populations over the same time period (all p<0.001). The decrease in use of sulfonylureas was greater among those without CKD (p<0.05). From 2006-16 metformin use increased considerably from 30% to 44% among individuals with CKD and from 47% to 56% among individuals without CKD. In 2016, metformin became the most common therapy for both populations, followed by insulins. Insulin use slightly decreased after 2014, from 44% to 40% among those with CKD and 25% to 23% in those without CKD (p<0.01).
Conclusion
Use of SGLT2 inhibitors, incretin-based therapies, and metformin increased among individuals with and without CKD, suggesting that safety data has driven evidence-based practice. Nevertheless, substantial treatment differences exist in diabetes therapy among those with and without CKD suggesting that other strategies may be needed to accelerate translation of evidence to practice.
Funding
- Other U.S. Government Support