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Kidney Week

Abstract: PO1029

Utilization of Glucose-Lowering Medications Among US Medicare Beneficiaries with CKD Between 2007 and 2016

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Zhao, Julie, University of Minnesota, Minneapolis, Minnesota, United States
  • Weinhandl, Eric D., University of Minnesota, Minneapolis, Minnesota, United States
  • Carlson, Angeline M., University of Minnesota, Minneapolis, Minnesota, United States
  • St. Peter, Wendy L., University of Minnesota, Minneapolis, Minnesota, United States
Background

Selecting effective and safe glucose-lowering medications for chronic kidney disease (CKD) patients is challenging. Twelve classes of glucose-lowering medications are on the US market today. Information regarding utilization of glucose-lowering medications in patients with CKD is limited.

Methods

We evaluated an adult CKD population from Medicare 5% random sample 2007-2016, provided by the United States Renal Data System. Yearly cohorts of patients with CKD and type 2 diabetes were created. Descriptive statistics were used to report proportions of patients using glucose-lowering medications. To test overall trends in glucose-lowering medication classes, linear probability models with adjustment for age, sex, race/ethnicity, CKD stage, and low-income subsidy (LIS) status were used.

Results

Use of metformin, newer glucose-lowering medication classes (DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors), and newer insulin analogs (aspart, lispro, glulisine, detemir, glargine, degludec) showed statistically significant upward trends during the study timeframe. Sitagliptin was the most commonly prescribed DPP-4 inhibitor; use increased from 5.6% in 2007 to 15.0% in 2016. Use of linagliptin (approved in 2011) increased from 0.1% in 2011 to 6.0% in 2016. Compared with other GLP-1 receptor agonists, use of liraglutide (approved in 2010) increased more (0.3% in 2010 to 3.6% in 2016), and use was higher in 2016. Use of SGLT2 inhibitors (canagliflozin, empagliflozin, or dapagliflozin) remained very low in 2016, but use was increasing. Use of newer analog insulin therapy increased, especially insulin detemir (2.4% in 2007 to 11.7% in 2016). Insulin was the most highly used single medication class in 2016. The most highly used dual combination therapies in 2016 were metformin and sulfonylureas and metformin and insulin. Combination therapy was less common as CKD stage increased.

Conclusion

Use of metformin and newer glucose-lowering medication classes is increasing in CKD patients with type 2 diabetes. We anticipate that percentages of CKD patients using these newer agents will increase.