Glucose-lowering treatment pathways of individuals with chronic kidney disease and type 2 diabetes according to the Kidney Disease: Improving Global Outcomes 2012 risk classification.

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  • Additional Information
    • Source:
      Publisher: Blackwell Science Country of Publication: England NLM ID: 8500858 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-5491 (Electronic) Linking ISSN: 07423071 NLM ISO Abbreviation: Diabet Med Subsets: MEDLINE
    • Publication Information:
      Publication: Oxford : Blackwell Science
      Original Publication: Chichester [Sussex, England] ; New York : Wiley, [c1984-
    • Subject Terms:
      Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/drug therapy ; Metformin*/adverse effects ; Metformin*/therapeutic use ; Renal Insufficiency, Chronic*/complications ; Renal Insufficiency, Chronic*/drug therapy ; Renal Insufficiency, Chronic*/epidemiology; Adolescent ; Adult ; Humans ; Glomerular Filtration Rate ; Glucose ; Retrospective Studies
    • Abstract:
      Aims: To describe treatment pathways for key glucose-lowering therapies in individuals with chronic kidney disease (CKD) and type 2 diabetes (T2D) using retrospective data from DISCOVER CKD (NCT04034992).
      Methods: Data were extracted from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics data (2008-2020) and the US integrated Limited Claims and Electronic Health Records Database (LCED; 2012-2019). Eligible individuals were aged ≥18 years with CKD, identified by two consecutive estimated glomerular filtration rate (eGFR) measures (15-<75 mL/min/1.73 m 2 ; 90-730 days apart; index date was the second measurement) and T2D. Chronological treatment pathways for glucose-lowering therapies prescribed on or after CKD index to end of follow-up were computed. Median time and proportion of overall follow-up time on treatment were described for each therapy by database and by eGFR and urinary albumin-to-creatinine ratio (UACR) categories.
      Results: Of 36,951 and 4339 eligible individuals in the CPRD and LCED, respectively, median baseline eGFR was 67.8 and 64.9 mL/min/1.73 m 2 ; 64.2 and 63.9% received metformin prior to index; and median (interquartile range) time on metformin during follow-up was 917 (390-1671) and 454 (192-850) days (accounting for ~75% of follow-up time in both databases). The frequency of combination treatment increased over time. There were trends towards decreased metformin prescriptions with decreasing eGFR and increasing UACR within each eGFR category.
      Conclusions: Individuals with CKD and T2D had many combinations of therapies and substantial follow-up time on therapy. These results highlight opportunities for improved CKD management.
      (© 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)
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    • Grant Information:
      AstraZeneca
    • Contributed Indexing:
      Keywords: database; diabetes mellitus, type 2; electronic health records; glomerular filtration rate; metformin; renal insufficiency, chronic; retrospective studies
    • Molecular Sequence:
      ClinicalTrials.gov NCT04034992
    • Accession Number:
      IY9XDZ35W2 (Glucose)
      9100L32L2N (Metformin)
    • Publication Date:
      Date Created: 20230814 Date Completed: 20240125 Latest Revision: 20240125
    • Publication Date:
      20240126
    • Accession Number:
      10.1111/dme.15200
    • Accession Number:
      37578188