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Kidney Week

Abstract: FR-PO256

Antidiabetic Medication Use in Patients with Type 2 Diabetes and CKD

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Rhee, Jinnie J., Stanford University School of Medicine, Palo Alto, California, United States
  • Han, Jialin, Stanford University, Menlo Park, California, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Palo Alto, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
Background

Diabetes care and relevant clinical practice guidelines are continuously evolving, yet little is known about how to optimize type 2 diabetes mellitus (T2DM) care in patients with chronic kidney disease (CKD). We therefore sought to describe treatment approaches for glycemic control in patients with T2DM and CKD by examining patterns of newer (GLP1-ra and DPP-4i) and conventional (metformin, SU, TZD, and insulin) antidiabetic medication use in this patient population by using data from 2015.

Methods

We used data from a large claims and integrated database that includes employed and commercially insured patients in the United States (Optum). We selected adults age ≥18 years who had continuous enrollment between January 1, 2014 and January 1, 2015, restricting the cohort to patients who had T2DM and CKD prior to January 1, 2015. We defined medication use according to pharmacy fill information for two newer classes (GLP-1ra and DPP-4i) and four conventional classes of antidiabetic medications (metformin, SU, TZD, and insulin). We stratified our analyses by age, sex, race, ethnicity, income, geographic region, CKD stage, and prescribing provider specialty. The final cohort consisted of 38,577 patients.

Results

In 2015, metformin was the most common medication prescribed to patients in this cohort (49.2%). Among the newer medications, 3.4% of patients were prescribed GLP-1ra and 12.3% of patients were treated with DPP-4i. Among patients in CKD stage 1-3a, metformin remained the most commonly prescribed medication. The proportion of patients who were prescribed DPP-4i and insulin was higher in advanced CKD whereas the proportion of patients who were prescribed GLP-1ra was highest in patients with CKD stage 1. There were wide variations by sociodemographic factors. Generally, patients who received prescriptions for antidiabetic medications from nephrologists remained low (0.4-1.9%). Among patients who received prescriptions for GLP-1ra, most received their prescriptions from endocrinologists whereas patients treated with other classes of medications had their prescriptions written most frequently by PCPs.

Conclusion

Prescriptions for newer antidiabetic medications with known safety and efficacy remained low. Prescriptions for agents that are contraindicated in advanced CKD continued to be written. GLP-1ra were favored primarily by endocrinologists.

Funding

  • NIDDK Support