Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2000-2021]
    • Subject Terms:
      General Practice*; Diabetes Mellitus, Type 2/*drug therapy ; Dipeptidyl-Peptidase IV Inhibitors/*administration & dosage ; Hypoglycemic Agents/*administration & dosage ; Metformin/*administration & dosage ; Renal Insufficiency, Chronic/*metabolism ; Sodium-Glucose Transporter 2 Inhibitors/*administration & dosage ; Sulfonylurea Compounds/*administration & dosage; Aged ; Aged, 80 and over ; Australia ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/metabolism ; Female ; Glomerular Filtration Rate ; Glycated Hemoglobin/metabolism ; Humans ; Male ; Middle Aged ; Renal Insufficiency, Chronic/complications
    • Abstract:
      Background: Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Since these publications, a number of new medications have become available for the management of T2D. Study aims were to, in a cohort of Australians with T2D and renal impairment attending general practice, (1) investigate whether the prescribing of non-insulin diabetes medications is consistent with dosing adjustments recommended within current Australian Diabetes Society (ADS) guidelines; and (2) identify patient socio-demographic and clinical factors associated with at least one prescription of a non-insulin diabetes medication inconsistent with current ADS guidelines for medication doses.
      Methods: Cross-sectional study using data from the MedicineInsight general practice database managed by NPS MedicineWise. Patients with T2D who were aged 18 years and over, with an average eGFR< 60 ml/min/1.73m 2 and at least one prescription of a non-insulin diabetes medication between 1st January 2015 and 30th June 2017 were included. Descriptive statistics were used to summarise patient characteristics and medication use. Marginal logistic regression models were used to estimate associations between sociodemographic and clinical factors and prescribing of ≥1non-insulin diabetes medicine not consistent with ADS guidelines.
      Results: The majority of the 3505 patients included (90.4%) had an average eGFR of 30-59 ml/min/1.73m 2 . In terms of absolute numbers, metformin was the medication most frequently prescribed at a dose not consistent with current ADS guidelines for dosing in renal impairment (n = 1601 patients), followed by DPP4 inhibitors (n = 611) and sulphonylureas (n = 278). The drug classes with the highest proportion of prescriptions with dosage not consistent with ADS guidelines were SGLT2 inhibitors (83%), followed by biguanides (58%) and DPP4 inhibitors (46%). Higher HbA1c, longer known diabetes duration and diagnosis of retinopathy were associated with receiving ≥1prescription with a dosage not consistent with guidelines.
      Conclusions: Prescribing of non-insulin diabetes medications at doses inconsistent with current ADS guideline recommendations for dosing adjustments for people with renal impairment was common. Further research is needed to understand how general practitioners access, interpret and apply the ADS guidelines and the impact this may have on patient outcomes.
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    • Contributed Indexing:
      Keywords: Anti-diabetes medications; Australia; Chronic kidney disease; General practice; Guidelines; Prescribing; Renal impairment; Type 2 diabetes
    • Accession Number:
      0 (Dipeptidyl-Peptidase IV Inhibitors)
      0 (Glycated Hemoglobin A)
      0 (Hypoglycemic Agents)
      0 (Sodium-Glucose Transporter 2 Inhibitors)
      0 (Sulfonylurea Compounds)
      0 (hemoglobin A1c protein, human)
      9100L32L2N (Metformin)
    • Publication Date:
      Date Created: 20190220 Date Completed: 20200210 Latest Revision: 20240714
    • Publication Date:
      20240714
    • Accession Number:
      PMC6378720
    • Accession Number:
      10.1186/s12875-019-0915-x
    • Accession Number:
      30777033