Abstract
Background: Information regarding the use of glucose-lowering medications in patients with chronic kidney disease (CKD) is limited. Study Design: Retrospective cohort study. Setting & Participants: Medicare 5% random sample of patients with CKD with type 2 diabetes, 2007 to 2016. Predictors: Study year, CKD stage, low-income subsidy status, and demographic characteristics (age, sex, and race/ethnicity). Outcomes: Trends in use of glucose-lowering medications. Analytical Approach: Yearly cohorts of patients with CKD and type 2 diabetes were created. Descriptive statistics were used to report proportions of patients using glucose-lowering medications. To test overall trends in glucose-lowering medication classes, linear probability models with adjustment for age, sex, race/ethnicity, CKD stage, and low-income subsidy status were used. Results: Metformin use increased significantly from 32.7% in 2007 to 48.7% in 2016. Use of newer classes of glucose-lowering medications increased significantly, including dipeptidyl peptidase 4 inhibitors (5.6%, 2007; 21.7%, 2016), glucagon-like peptide 1 receptor agonists (2.3%, 2007; 6.1%, 2016), and sodium-glucose cotransporter 2 inhibitors (0.2%, 2013; 3.3%, 2016). Newer insulin analogue use increased from 37.2% in 2007 to 46.3% in 2013 and then remained steady. Use of sulfonylureas, thiazolidinediones, older insulins (human regular and neutral protamine Hagedorn), α-glucosidase inhibitors, amylin mimetics, and meglitinides decreased significantly. Insulin was the most highly used single medication class. Insulin use was higher among low-income subsidy than among non–low-income subsidy patients. Combination therapy was less common as CKD stage increased. Limitations: Patients with CKD and type 2 diabetes and the CKD stages were identified with diagnosis codes and could not be verified through medical record review. Our results may not be generalizable to younger patients with CKD with type 2 diabetes. Conclusions: Use of metformin and newer glucose-lowering medication classes is increasing in patients with CKD with type 2 diabetes. We anticipate that percentages of patients with CKD using these newer agents will increase.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 173-182.e1 |
| Journal | Kidney Medicine |
| Volume | 3 |
| Issue number | 2 |
| DOIs | |
| State | Published - Dec 29 2020 |
Bibliographical note
Funding Information:Julie Z. Zhao, MPH, Eric D. Weinhandl, PhD, MS, Angeline M. Carlson, PhD, and Wendy L. St. Peter, PharmD. Research idea and study design: JZZ, AMC, WLSP; data acquisition: JZZ, WLSP; data analysis/interpretation: JZZ, EDW, WLSP; statistical analysis: JZZ, EDW, WLSP; supervision or mentorship: WLSP. Each author contributed important intellectual content during manuscript drafting or revision, accepts personal accountability for the author's own contributions, and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. The authors received no specific funding for this work. The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. Government. The authors declare that they have no relevant financial interests. The authors thank Nan Booth, MSW, MPH, ELS, of the Chronic Disease Research Group for manuscript editing. Received June 24, 2020. Evaluated by 2 external peer reviewers, with direct editorial input by the Statistical Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form September 13, 2020.
Publisher Copyright:
© 2020 The Authors
Keywords
- CKD stage
- Chronic kidney disease (CKD)
- Medicare Part D
- diabetes
- glucose-lowering medications
- utilization trends
