Secular trends in antihyperglycaemic medication prescriptions in older adults with diabetes and chronic kidney disease: 2004–2013

Clemens, Kristin K.; Liu, Kuan; Shariff, Salimah Z.; Schernthaner, Guntram; Tangri, Navdeep; Garg, Amit X.

doi:10.1111/dom.12658

Cited by 25 publications

(26 citation statements)

References 40 publications

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“…Despite the increase in linagliptin use, insulin, sulphonylureas, metformin and other DPP‐4 inhibitors, that is sitagliptin, remain the most frequently chosen agents among T2DM patients with moderate to severe renal impairment. While the choice of traditional antidiabetic agents that is insulin, short‐acting sulphonylureas and meglitinides is acknowledged, and the increasing role of metformin has been previously observed, the prominent role of DPP‐4 inhibitors among T2DM patients with kidney disease in recent years has been largely undocumented. Such extensive use in clinical practice is unforeseen, as the data on the effects of DPP‐4 inhibitors in patients with diabetes and kidney dysfunction in routine care are limited, and current guidelines do not specifically recommend the preferential use of these agents over alternative treatments in this population .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increase in linagliptin use, insulin, sulphonylureas, metformin and other DPP-4 inhibitors, that is sitagliptin, remain the most frequently chosen agents among T2DM patients with moderate to severe renal impairment. While the choice of traditional antidiabetic agents that is insulin, short-acting sulphonylureas and meglitinides is acknowledged, 5 and the increasing role of metformin has been previously observed, 6,7 Age, mean (SD) 60. 2 (12.4) 61.…”

Section: Discussionmentioning

confidence: 99%

“…6 (12.7) 56.4 (10. 7) 66.9 (12.6) 62. 5 (13.5) Females, N (%) Other DPP-4i, other DPP-4 inhibitors (i.e alogliptin, saxagliptin and sitagliptin); 2nd gen SU, 2nd generation sulphonylureas (i.e glipizide, glimepiride, glyburide); GLP-1 RA, GLP-1 receptor agonists (i.e albiglutide, dulaglutide, exenatide, liraglutide); glitazones, thiazolidinediones (i.e rosiglitazone, pioglitazone); glinides, meglitinides (i.e nateglinide, repaglinide); SGLT2i, SGLT-2 inhibitors (i.e canagliflozin, dapagliflozin, empagliflozin); SD, standard deviation; CKD, chronic kidney disease, assessed through ICD-9 diagnosis codes; HbA1c, haemoglobin A1c; eGFR, estimated glomerular filtration rate.…”

Section: Discussionmentioning

confidence: 99%

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Preferential prescribing and utilization trends of diabetes medications among patients with renal impairment: Emerging role of linagliptin and other dipeptidyl peptidase 4 inhibitors

Patorno

Gopalakrishnan

Bartels

et al. 2017

Endocrino Diabet & Metabol

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Summary Objectives Although many newer diabetes medications have become available in the last decade, most have not been widely studied in populations with chronic kidney disease under routine care. Linagliptin, a recently marketed dipeptidyl peptidase 4 (DPP‐4) inhibitor, is the only agent in the U.S. that does not require dose adjustment in patients with diabetes mellitus type 2 (T2DM) and renal impairment. We sought to describe baseline kidney function and other key characteristics among patients with diabetes mellitus type 2 (T2DM) initiating linagliptin and other diabetes medications, and to explore prescribing patterns among T2DM patients with moderate to severe renal impairment before and after the launch of linagliptin. Design Using a population‐based cohort study design nested in a large U.S. commercial healthcare dataset linked to laboratory values, we described characteristics of T2DM patients initiating linagliptin and other diabetes medications between May 2011 (launch of linagliptin) and September 2015. We also explored prescribing trends among T2DM patients with moderate to severe renal impairment (ICD‐9 diagnosis code 585.3x‐6x) who initiated linagliptin and other diabetes medications between January 2006 to September 2015 (before and after the launch of linagliptin). Patients We identified 1,174,476 T2DM patients initiating a diabetes medication (28,900 linagliptin initiators) between 05/2011‐09/2015. We also identified 100,847 T2DM patients with moderate to severe renal impairment initiating a diabetes agent between 01/2006‐09/2015. Results and Conclusion Among patients initiating newer diabetes medications between 05/2011‐09/2015, those initiating linagliptin had the highest prevalence of moderate to severe renal impairment, suggesting preferential prescribing in routine care. DPP‐4 inhibitors overall were among the most frequently chosen agents among T2DM patients with moderate to severe renal impairment between 01/2006‐09/2015. Further investigation of the safety and effectiveness of DPP‐4 inhibitors in routine care of T2DM patients with renal impairment is needed to either corroborate or discourage current prescribing patterns.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preferential prescribing and utilization trends of diabetes medications among patients with renal impairment: Emerging role of linagliptin and other dipeptidyl peptidase 4 inhibitors

Patorno

Gopalakrishnan

Bartels

et al. 2017

Endocrino Diabet & Metabol

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“…Based on their data the authors concluded that metformin may be safer for use in CKD than previously considered and may lower the risk of death and cardiovascular events in individuals with stage 3 CKD. A population-based study of 144,252 older adults with diabetes and chronic kidney disease in Canada/Ontario showed that up to 27.6% of patients with CKD stage 4-5 disease or receiving chronic dialysis were prescribed metformin [35]. Metformin should not be used in patients with stage 5 CKD [36], since diabetic patients from Taiwan presenting with high serum creatinine values > 6 mg (>530 lmol/l) had an increased mortality (aHR: 1.35; 95% CI: 1.20-1.51; p < 0.0001) when they used metformin [37].…”

Section: Metformin In Patients With Ckdmentioning

confidence: 99%

The right place for metformin today

Schernthaner

2020

Diabetes Research and Clinical Practice

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“…Comorbidities and chronic complications are highly prevalent among people with T2DM, necessitating a multifactorial approach to management. In addition, other characteristics (such as age, sex, duration of disease, race and ethnicity) require individualization of patient care …”

Section: Introductionmentioning

confidence: 99%

Effects of exenatide once weekly plus dapagliflozin, exenatide once weekly alone, or dapagliflozin alone added to metformin monotherapy in subgroups of patients with type 2 diabetes in the DURATION‐8 randomized controlled trial

Frías

Hardy

Ahmed³

et al. 2018

Diabetes Obesity Metabolism

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This analysis assessed whether responses with exenatide once weekly plus dapagliflozin (n = 231), exenatide once weekly alone (n = 230), or dapagliflozin alone (n = 233) differed in key patient subpopulations of the DURATION‐8 trial. Potential treatment‐by‐subgroup interactions for changes in glycated haemoglobin (HbA1c) and body weight after 28 weeks were evaluated among subgroups determined by baseline HbA1c, age, sex, body mass index, type 2 diabetes duration, race, ethnicity and estimated glomerular filtration rate (eGFR). Exenatide once weekly plus dapagliflozin reduced HbA1c and body weight across all subgroups: least‐squares mean reductions ranged from −8.4 to −26.1 mmol/mol (−0.77% to −2.39%) for HbA1c and from −2.07 to −4.55 kg for body weight. Potential treatment‐by‐subgroup interactions (P < .10) were found for HbA1c change by age (P = .016) and eGFR (P = .097). Age subgroup analysis findings were not consistent with expected mechanistic effects, with the small number of patients aged ≥65 years (n = 74 vs n = 499 for patients aged <65 years) limiting the interpretability of the interaction term. In the exenatide once weekly plus dapagliflozin and dapagliflozin groups, but not the exenatide once weekly group, HbA1c reductions were greater among patients with eGFR ≥90 vs ≥60 to <90 mL/min/1.73 m2 (least‐squares mean reductions of −23.6 vs −19.0 mmol/mol [−2.16% vs −1.74%], −17.3 vs −12.0 mmol/mol [−1.58% vs −1.10%], and −17.7 vs −16.9 mmol/mol [−1.62% vs −1.55%] for the respective treatments); this was consistent with the mechanism of action of dapagliflozin. A potential treatment‐by‐subgroup interaction was observed for change in body weight by sex (P = .099), with greater weight loss for women vs men across all treatments (range −2.56 to −3.98 kg vs −0.56 to −2.99 kg). In conclusion, treatment with exenatide once weekly plus dapagliflozin reduced HbA1c and body weight across all patient subgroups and was more effective than exenatide once weekly or dapagliflozin alone in all adequately sized subgroups.

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Secular trends in antihyperglycaemic medication prescriptions in older adults with diabetes and chronic kidney disease: 2004–2013

Abstract: In patients with chronic kidney disease, there were trends towards safer antihyperglycaemic medication prescribing. A considerable number of patients, however, continue to receive medications that should be avoided.

Cited by 25 publications

References 40 publications

Preferential prescribing and utilization trends of diabetes medications among patients with renal impairment: Emerging role of linagliptin and other dipeptidyl peptidase 4 inhibitors

Preferential prescribing and utilization trends of diabetes medications among patients with renal impairment: Emerging role of linagliptin and other dipeptidyl peptidase 4 inhibitors

The right place for metformin today

Effects of exenatide once weekly plus dapagliflozin, exenatide once weekly alone, or dapagliflozin alone added to metformin monotherapy in subgroups of patients with type 2 diabetes in the DURATION‐8 randomized controlled trial

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