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Highlights• In a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) participants with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), we observed an increased use of metformin (59%-68%) and a decreased use of sulfonylureas (55%-37%) and thiazolidinediones (25%-5%) in 2013-2016 compared to 2006-2008. • Guideline-discordant use of metformin (8% of CKD stage 4/5) and glyburide (3% of CKD stages 3-5) observed in 2013-2016 warrants stronger policy implementations regarding inappropriate drug use. AbstractBackground: There is little information on medication use, trends across time, and the impact of guidelines on appropriate use of antidiabetic drugs in participants with type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD). Methods: A cross-sectional analysis of the National Health and NutritionExamination Survey (NHANES) from 2005-2016 was carried out for participants with T2DM with and without CKD. Multivariate survey-weighted regression models were used to evaluate trends in antidiabetic drug use across the time periods and CKD severity. Guideline-discordant use of metformin and glyburide were assessed among those with glomerular filtration rate and serum creatinine-based contraindications. Results: Out of 3237 study participants with T2DM, 35.9% had CKD. Comparing 2013-2016 with 2005-2008, use of metformin (non-CKD: 69% vs 83.8%, CKD: 58.6% vs 68.2%) increased, whereas the use of sulfonylureas (non-CKD: 46.3% vs 27.2%, CKD: 54.7% vs 36.6%) and thiazolidinediones (non-CKD: 29.3% vs 3.9%, CKD: 24.6% vs 5.5%) decreased. In combined NHANES cycles and

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Background: Cardiovascular (CV) event risk, healthcare resource utilization (HCRU) and costs have not been elucidated among hypertension patients with treated insomnia (H + TI). Materials & methods: Adult patients with H + TI were identified in IBM MarketScan databases. H + TI patients were matched 1:1 on age and sex to controls with hypertension but without sleep disorders. Multivariable models were used to estimate associations between treated insomnia and CV event risk, HCRU and costs. Results: In total, 81,502 H + TI patients (mean age = 62 years, 53% female) were matched. Relative to controls, H + TI patients were 2.4 times as likely to have CV events. H + TI patients incurred higher costs per patient per month (US$2343 vs US$1013). Conclusion: Treated insomnia was associated with higher costs and HRCU in hypertension patients.

Diabetes is a highly prevalent chronic metabolic disease that affects 9.4% of the U.S. population. 1 Chronic kidney disease (CKD), a common comorbidity and complication of the disease, is estimated to affect approximately 35%-40% of patients with type 2 diabetes mellitus (T2DM). 2 The risks of cardiovascular complications, hospitalization, and death increase with decreasing kidney function. 3 In addition, patients with diabetes and CKD have substantially higher medical care costs compared with those patients with diabetes alone. 4 Achieving glycemic control using pharmacotherapy is essential for the avoidance of disease progression and diabetesrelated complications. Glycemic control has also been associated with better clinical outcomes, including reduced risks of cardiovascular events and progression of CKD and end-stage renal disease (ESRD) among patients with CKD. 5 Numerous studies have demonstrated the role of adherence in attaining glycemic targets and potential savings for patients with T2DM. 6 For every 10% increase in adherence, hemoglobin A1c (HbA1c) decreases by approximately 0.1%. 6 Nonadherence has been associated with 7% higher risk of hospitalization, 3.6% higher mean number of visits, and 10% higher risk of mortality. 6,7 Studies have suggested reductions in total medical cost,