Antidiabetic drug use trends in patients with type 2 diabetes mellitus and chronic kidney disease: A cross‐sectional analysis of the National Health and Nutrition Examination Survey

Abstract

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

Renal effectiveness and safety of the sodium-glucose cotransporter-2 inhibitors: a population-based cohort study

“…8 9 Given the burden of diabetic nephropathy as a chronic complication of diabetes and a leading cause of death, this renal protective effect deems SGLT-2 inhibitors as a valuable therapeutic option and potentially explains their increased utilization rates. [10][11][12] Despite these demonstrated renal benefits, SGLT-2 inhibitor use has been linked with an increased risk of acute kidney injury (AKI) by case reports, leading to a series of safety warnings by several regulatory bodies. 13 14 This was hypothesized to be due to volume depletion and systematic blood pressure reduction resulting from the SGLT-2 inhibitor-induced glucosuric osmotic diuresis.…”

Cannabinoids and PPAR Ligands: The Future in Treatment of Polycystic Ovary Syndrome Women with Obesity and Reduced Fertility

“…Two thiazolidinediones, rosiglitazone and pioglitazone, are used in clinical practice for the management of DM-2. Thiazolidinediones improve the response to insulin, increasing insulin sensitivity in crucial tissues, subsequently promoting insulin-dependent glucose absorption in muscle and fat, increased adiponectin levels (a cytokine secreted by adipose tissue that increases insulin sensitivity and fatty acid oxidation), and decreased hepatic gluconeogenesis [ 200 , 201 , 202 , 203 , 204 ]. PPARγ activation by glitazones alters expression levels of many genes involved in glucose and fatty acid metabolism, such as lipoprotein lipase, glucokinase, and fatty acyl-CoA synthase [ 205 ].…”

Novel Thiazolidinedione and Rhodanine Derivatives Regulate Glucose Metabolism, Improve Insulin Sensitivity, and Activate the Peroxisome Proliferator-Activated γ Receptor

“…Improvement of insulin resistance by PPAR-γ agonists has been attributed to increasing adiponectin and GLUT4 expression and opposing the effect of TNF-α in adipocytes. Increased GLUT4 expression increases the glucose uptake in adipocytes and skeletal muscle cells in response to insulin . Activation of PPAR-γ receptors could also induce apoptosis for cancer cells, slow the progression of medial intimal thickening, and decrease coronary intimal hyperplasia .…”

“…They are not hypoglycemic when administrated as monotherapy and not contraindicated in patients with renal disease. In addition, they reduce hepatic fats and improve liver fibrosis in patients with nonalcoholic steatohepatitis. − TZDs also regulate gene expression activated by PPAR-γ . These genes are found in muscle, fat, and liver tissues.…”