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BMC Nephrol. 2016 Jun 11;17(1):59. doi: 10.1186/s12882-016-0273-z.

Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease - cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort.

Author information

1
Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, D - 07747, Jena, Germany. martin.busch@med.uni-jena.de.
2
Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
3
Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, D - 07747, Jena, Germany.
4
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
5
Department of Internal Medicine IV, Medical Center University of Freiburg, Freiburg, Germany.
6
Department of Medicine, Division of Nephrology and Medical Intensive Care, University Hospital Charité, Berlin, Germany.
7
Hannover Medical School, Clinic for Nephrology, Hannover, Germany.
8
Department of Medicine II - Nephrology and Clinical Immunology, University Hospital Aachen, Aachen, Germany.
9
Department of Medicine, Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany.
10
Department of Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
11
Department of Medicine IV, Division of Nephrology, University Hospital of Ludwig-Maximilians University Munich, Munich, Germany.
12
Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.

Abstract

BACKGROUND:

Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD.

METHODS:

The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) between 30-60 mL/min/1.73 m(2) or proteinuria >0.5 g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure.

RESULTS:

At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25(th)-75(th) percentile: 6.8-7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral antidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was used by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase of 1 kg/m(2), 95 % CI 1.02-1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04-1.18), treatment with insulin alone (OR = 5.63, 95 % CI 4.26-7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77-6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides.

CONCLUSIONS:

Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels.

KEYWORDS:

Chronic kidney disease; Diabetes mellitus; Glycaemic control; Hemoglobin A1C; Insulin therapy; Oral antidiabetic drugs

PMID:
27286816
PMCID:
PMC4902996
DOI:
10.1186/s12882-016-0273-z
[Indexed for MEDLINE]
Free PMC Article

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