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Abstract: SA-PO488

Use of Medicines to Protect Kidney Function Among Patients with Type 2 Diabetes (T2DM) and CKD in the United States

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • Yu, Miao, University of Michigan, Ann Arbor, Michigan, United States
  • Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
  • Herman, William H., University of Michigan, Ann Arbor, Michigan, United States
  • Vassalotti, Joseph A., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Xu, Fang, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Newer classes of diabetes, kidney, and cardioprotective medicines, such as SGLT2i and GLP1a, have shown better outcomes among diabetic patients. We examined the use of SGLT2i and GLP1a among patients with T2DM and CKD in the US.

Methods

We identified 425,879 patients aged ≥20 years diagnosed with T2DM and CKD (mean age: 73.9 years) from Optum ClinformaticsTMdata. Medical history and specialist visits in 2019 were defined by ICD codes and provider ID (nephrology, cardiology, and endocrinology). We examined specific medicine use(SGLT2i, GLP1a, ACEIs/ARBs, and statins) in 2020. Combination therapy was defined as the overlapped use of medicines for ≥ 30 days. Logistic regression model was applied to examine factors related to medication use.

Results

SGLT2i use was observed among 5.5% of patients with type 2 diabetes and CKD, with higher usage in CKD stage G1–2 (6.2%) compared with other stages (G3: 4.6%, G4: 2.1%, and G5: 2.8%, P < .0001). About 8.0% of patients used GLP1a, with a higher usage in CKD stage G3 (7.9%) compared with early stages and advanced stages (G1–2: 7.5%, G4: 7.1%, and G5: 5.7%, P < .001). After adjusting for demographics and other covariates, having endocrinologist visits, being covered by Exclusive Provider Organization plans (compared to Health Maintenance Organization plans), and being covered by Point of Service plans, were found to be significant predictors of using SGLT2i and GLP1a (Table).

Conclusion

We document low use of SGLT2i and GLP1a among diabetic patients with CKD in 2020. Given encouraging results from several recent, large randomized clinical trials, especially with SGLT2i, our study suggests an ongoing need for investigating barriers and disparities in the real-world use of these medicines.

Funding

  • Other U.S. Government Support