Utilization of glucagon‐like peptide‐1 receptor agonists and changes in clinical characteristics in patients with type 2 diabetes by chronic kidney disease stage in Japan: A descriptive observational study using a nationwide electronic medical records database

Abstract

Aim: To describe the utilization of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and changes in clinical characteristics before and after GLP-1 RA initiation in patients with type 2 diabetes (T2D) by chronic kidney disease (CKD) stage. Materials and Methods:In this retrospective descriptive study using a nationwide electronic medical records database in Japan, we included patients with GLP-1 RA prescriptions from June 2010 to October 2019. Clinical characteristics at GLP-1 RA initiation, persistence proportion, and changes in clinical measurements after GLP-1 RA initiation were described for all patients and by CKD stage, defined by baseline estimated glomerular filtration rate (eGFR).Results: We included 8049 patients. During the study period, the proportion of patients with T2D initiating GLP-1 RAs increased from 1.5% in 2010 to 3.3% in 2019. Also, the mean (95% confidence interval) of baseline age and eGFR ranged from 58.6 (56.7-60.4) to 66.3 (65.5-67.2) years and from 72.9 (68.0-77.9) to 64.0 (62.2-65.8) mL/min/1.73m 2 , respectively. The persistence proportion at 12 months was 49.5% overall, 37.8% in T2D patients with CKD with a baseline eGFR of less than 30 mL/min/1.73m 2 , and 34.6% in those undergoing dialysis. The rate of deterioration in renal function reduced after GLP-1 RA initiation. Conclusions:The utilization of GLP-1 RAs has been increasing over the past decade, and GLP-1 RAs have been used in patients with limited treatment options, such as the elderly or those with CKD. In T2D patients with CKD, the persistence proportion of GLP-1 RAs was not low, and the renal dysfunction may be moderated by GLP-1 RA initiation.

Effect of multidisciplinary care on diabetic kidney disease: a retrospective cohort study

“…We extracted data of patients with diagnostic codes for DKD (E112 and E142) [ 25 ] for whom diagnostic codes for T2DM (E11–E14) had been assigned before the index date (date when the diagnostic codes for DKD were assigned). Other inclusion criteria were age ≥ 20 years at index date and an index estimated glomerular filtration rate (eGFR; defined as the eGFR measured close to the index date [within 90 days]) of 15–90 mL/min/1.73 m 2 .…”

Safety and Efficacy of GLP-1 Receptor Agonists in Type 2 Diabetes Mellitus with Advanced and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

“…Ultimately, 8 studies consisting of 27,639 patients were included in this systematic review. These 8 studies were comprised of 4 non-randomized controlled studies [21,23,25,26], 3 retrospective cohorts [32][33][34], and 1 randomized controlled trial (RCT) [22] (Table 1).…”

“…Liraglutide was the most frequently used GLP-1RAs across 5 studies, with doses ranging from 0.3 to 1.8 mg daily [21][22][23]33,34]. Dulaglutide was also commonly reported in 3 studies with a fixed weekly dose of 0.75 mg [25,26,33], while lixisenatide was only reported in 1 study without dose description [33]. In 3 studies, GLP-1RAs were prescribed as a monotherapy [21,23,34].…”

“…The control group consisted of dipeptidyl peptidase-4 inhibitors (DPP-4is) in 3 studies [23,26,32], insulin in 2 studies [23,25], placebo in 1 study [22], and standard of care (Insulin, oral hypoglycemic drugs, and diet control) in 1 study [21]. Pretreatment data was available in 2 GLP-1RAs studies [33,34]. The median follow-up time was 3 months (IQR 3, 12), ranging from 5 weeks to 4 years.…”

“…The majority of patients included in this systematic review were from Asia, with 7 studies conducted in Asia and only 1 from Europe [22]. All 8 studies evaluated ESKD patients undergoing dialysis, while only 2 studies included a subgroup of stage 5 nondialysis (ND) CKD patients [32,33]. Overall, 54.4% of the patients were male, with a mean age of 64.8 ± 13.0 years and a mean body mass index (BMI) of 24.7 ± 4.6 kg/m 2 .…”