Noninsulin Antidiabetic Drugs for Patients with Type 2 Diabetes Mellitus: Are We Respecting Their Contraindications?

Abstract

Aim. To assess prescribing practices of noninsulin antidiabetic drugs (NIADs) in T2DM with several major contraindications according to prescribing information or clinical guidelines: renal failure, heart failure, liver dysfunction, or history of bladder cancer. Methods. Cross-sectional, descriptive, multicenter study. Electronic medical records were retrieved from all T2DM subjects who attended primary care centers pertaining to the Catalan Health Institute in Catalonia in 2013 and were pharmacologically treated with any NIAD alone or in combination. Results. Records were retrieved from a total of 255,499 pharmacologically treated patients. 78% of patients with some degree of renal impairment (glomerular filtration rate (GFR) < 60 mL/min) were treated with metformin and 31.2% with sulfonylureas. Even in the event of severe renal failure (GFR < 30 mL/min), 35.3% and 22.5% of patients were on metformin or sulfonylureas, respectively. Moreover, metformin was prescribed to more than 60% of patients with moderate or severe heart failure. Conclusion. Some NIADs, and in particular metformin, were frequently used in patients at high risk of complications when they were contraindicated. There is a need to increase awareness of potential inappropriate prescribing and to monitor the quality of prescribing patterns in order to help physicians and policymakers to yield better clinical outcomes in T2DM.

Evaluation of clinical and antidiabetic treatment characteristics of different sub-groups of patients with type 2 diabetes: Data from a Mediterranean population database

“…Since 2010 a special aid for prescription was integrated with our electronic medical records system that automatically alerts physicians of this contraindication. Compared with a previ-ously published study using the SIDIAP database, we could observe a lower prescription of both metformin and sulfonylureas: in 2013, 35.3% of patients with CKD stages 4-5 were receiving metformin and 22.5% sulfonylureas [40].…”

Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007–2013 in Catalonia: a population-based study

“… 5 Although a decrease in glinides and AGIs use has been reported in Spain, Japan and in the UK, 11 15 17 33 in our study the number of glinides prescriptions remained stable, which could be explained by the fact that in spite of their risk of hypoglycaemia, 5 they are the most used therapeutic class in patients with chronic kidney disease. 25 The decrease in AGIs might be explained by the high frequency of gastrointestinal side effects that led to the recommendation to only use them in people unable to use other oral glucose-lowering medications. 35 The decrease in the use of glitazones has been consistently documented in several studies that included data after 2007, 8 9 11–13 15 17 31–33 when the first regulatory warnings and the results of a meta-analysis alerted clinicians to cardiovascular risk associated with rosiglitazone, 36 37 and to a risk of bladder cancer with pioglitazone in 2011.…”

Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment

“…Pharmacological treatments were grouped as NIADs and insulin. GLP‐1RA was not grouped together with insulin as “injectable therapies” because local guidelines recommend them only when intensification is not possible with insulin, and because its use in our health region is very low (0.9% of patients) …”

“…GLP-1RA was not grouped together with insulin as "injectable therapies" because local guidelines recommend them only when intensification is not possible with insulin, and because its use in our health region is very low (0.9% of patients). 14,24 Time to first treatment intensification with any new antidiabetic treatment, any new NIAD and insulin was evaluated by time-to-event analysis with a competing-risks regression using the method of Fine and Gray, 25…”