Quality of diabetes mellitus therapy in patients with chronic kidney disease in the real world

Abstract

Patients affected by diabetes mellitus (DM) are at a high risk to develop chronic kidney disease (CKD). CKD is defined by the presence of structural or functional abnormalities, as persistent proteinuria or decreased glomerular filtration rate, for three months or more. CKD is estimated to affect about one-third of diabetic patients and DM is the leading cause of endstage renal disease.1 A recent American study confirmed the high prevalence of CKD in type 2 diabetes mellitus (T2DM), impacting around 40% of this population.2 An Australian study revealed that 23% of patients affected by T2DM had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 . The authors concluded that about 40% of patients had evidence of CKD.3 Recent Italian data from RIACE (renal insufficiency and cardiovascular events) study documented, in a large cohort of 15,773 Italian subjects with T2DM, CKD was observed in 37.5% of individuals, with a prevalence of stage 1-2 of 18.7% and stage 3-5 of 17.8%. 4 Therapeutic options for patients with renal failure are limited because a reduced GFR results in the accumulation of insulin and oral antidiabetic agents and an increased risk of hypoglycemia. There are no significant restrictions on the use of drugs in CKD stage 1 and 2, while in moderate and severe renal disease (stage 3-5) some antidiabetic agents are not recommended and others need dose adjustment. [5][6][7][8][9][10][11] The objective of the present study is to evaluate the appropriateness of DM treatment in patients with CKD in the real world. Materials and MethodsThe study included 265 diabetic patients consecutively admitted to internal medicine department of two Quality of diabetes mellitus therapy in patients with chronic kidney disease in the real world ABSTRACTChronic kidney disease (CKD) is very often among diabetic patients. Some oral antidiabetic agents are not recommended in the presence of CKD. Aim of the study was to evaluate the quality of diabetes mellitus (DM) treatment in nephrophatic patients in the real world. A total of 265 subjects with type 2 DM, consecutively admitted to the internal medicine departments of two hospitals in Rome, were recruited. Patients hospitalized for hypoglycemia, decompensated DM, acute kidney failure or worsening nephropathy were excluded. For each patient, the following data were collected: age, gender, estimated glomerular filtration rate (eGFR) using the MDRD (modification of diet in renal disease) study equation, type of antidiabetic drug treatment. A total of 265 subjects were studied, 127 male (47.9%) and 138 female (52.1%). The mean age was 77.5 years. The mean of glycemia glycated hemoglobin (HbA1c) value was 57.5 mmol/mol (7.4%). 137 patients (51.7%) were treated with oral antidiabetic agents, 29 (10%) with both oral antidiabetic agents and insulin, 90 (34%) with insulin alone, 8 (3%) with dipeptidyl peptidase-4 inhibitors, 1 (0.4%) with incretin agents plus oral antidiabetic drugs. According to the Kidney Disease Outcomes Quality Initiative (KDOQI) classification of CK...