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J Diabetes Complications. 2016 May-Jun;30(4):675-80. doi: 10.1016/j.jdiacomp.2016.01.016. Epub 2016 Jan 22.

Oral antidiabetics use among diabetic type 2 patients with chronic kidney disease. Do nephrologists take account of recommendations?

Author information

1
Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France; School of Medicine, University of Strasbourg, Rue Kirschleger, 67000, Strasbourg, France; UMR 1109, Laboratoire Immunologie et Rhumatologie, Strasbourg, France. Electronic address: clotilde-muller@hotmail.fr.
2
Haguenau Hospital, Nephrology department, 64 Avenue du Pr Leriche, 67500, Haguenau, France.
3
Clinique Ste Anne, Nephrology department, Rue Philippe Thyss, 67085, Strasbourg, France.
4
Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France.
5
Mulhouse Hospital, Nephrology department, 20 Avenue du Dr René Laennec, 68100, Mulhouse, France.
6
Strasbourg Civil Hospital, Nephrology department, 1 place de l'hôpital, 67000, Strasbourg, France; School of Medicine, University of Strasbourg, Rue Kirschleger, 67000, Strasbourg, France.

Abstract

BACKGROUND:

There is an increasing prevalence of diabetes type 2 and chronic kidney disease, challenging appropriate prescribing of oral anti-diabetic drugs (OADs).

METHODS:

We have described the practice patterns of 13 nephrologists in 4 centers, in a cohort of 301 consecutive adult type 2 diabetic patients. Among oral anti-diabetic prescriptions, we have detailed drugs dosage for each subject, with 3 different formulae for estimating glomerular filtration rate (GFR) and its adequation according to the latest ERBP recommendations (2015). As individuals were mostly obese in this work, we also compare adequacy rates using both standard indexed CKD-EPI formula and CKD-EPI formula de-indexed from body surface area.

RESULTS:

Using the CKD-EPI formula as the reference method for estimating GFR, 53.5% of patients were outside the recommendations, mostly for metformin (30% of the whole cohort) and for sitagliptin (17.9% of the whole cohort). With Cockcroft and Gault formula, 38.2% of persons were outside recommendations and 45.9% (p<0.001) with CKD-EPI de-indexed. Among individuals consulting a nephrologist for the first time (n=90), 61.1% were outside recommendations (p=0.1). Among those persons under diabetologist supervision (n=103), 63.1% were outside recommendations (p=0.09), and were taking significantly more often metformin and insulin.

CONCLUSION:

We have found a substantial number of inadequate OAD prescriptions in type 2 diabetic patients with chronic kidney disease. The proportion of individuals outside guidelines was strongly affected by the method used for estimating GFR and by the type of practice, i.e., specialists versus general practitioners.

KEYWORDS:

Chronic kidney disease; Diabetes mellitus; Drug safety; Kidney function estimation; Oral anti-diabetic therapy

PMID:
26900098
DOI:
10.1016/j.jdiacomp.2016.01.016
[Indexed for MEDLINE]

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