Renal function influences prescription patterns of glucose-lowering medications
Decreased renal function is associated with increased insulin use and decreased use of other glucose-lowering agents, a study has shown. Body mass index (BMI) and gender do not influence medication choice.
To investigate the effect of renal function on diabetes prescription and medication, researchers examined all prescriptions for 10,151 patients (mean age 64 years; 55.4 percent male; mean BMI, 31 kg/m2; mean estimated glomerular filtration rate [eGFR], 78 mL/min/1.73 m2) with both type 2 diabetes and hypertension seen ≥2 times during a 5-year period (2007 to 2012).
Of the patients, majority (>60 percent) used insulin, 50 percent used metformin and 25 percent used sulfonylurea derivatives. Dipeptidyl peptidase 4 (DPP4) and acarbose class drugs were prescribed in 10 percent of patients, GLP-1 in 8 percent, and other classes (eg, thiazolidinediones [TZD]) in <5 percent.
Patients were grouped into four, according to the glucose-lowering drugs they used: none (n=447; 4 percent), insulin only (n=3,836; 38 percent), other than insulin (n=2,910; 29 percent), and insulin combinations (n=2,955; 29 percent). Common combinations included insulin/metformin (n=2,493; 25 percent), insulin/sulfonylureas (n=706; 7 percent), metformin/sulfonylureas (n=2,017; 20 percent), metformin/GLP1 (n=949; 9 percent), metformin/DPP4 (n=895; 9 percent) and metformin/TZD (n=500; 5 percent).
It was found that insulin use increased from 35 to 70 percent as eGFR decreased to <30 mL/min/1.73 m2. Use of insulin in combination with other drugs dropped from 31 to 12 percent. Likewise, the use of other drugs alone without insulin dropped from 30 to 12 percent.
The present data demonstrate that prescription patterns are influenced by renal function and not by gender or BMI, researchers said. Additional studies are required to specifically determine the best glycaemia control strategies for populations with type 2 diabetes, hypertension and diminished renal reserve.
“The choice of antidiabetic agent may be especially important in those patients anticipated to require therapies that may result in either acute or prolonged diminished renal function,” they added.