Open Access2型糖尿病合并慢性肾病患者抗糖尿病药物使用趋势:国家健康与营养调查的横断面分析
Author(s) -
Gor Deval,
Gerber Ben S.,
Walton Surrey M.,
Lee Todd A.,
Nutescu Edith A.,
Touchette Daniel R.
Publication year - 2020
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.13003
Subject(s) - medicine , national health and nutrition examination survey , kidney disease , metformin , diabetes mellitus , guideline , renal function , cross sectional study , creatinine , type 2 diabetes mellitus , type 2 diabetes , endocrinology , population , environmental health , pathology
Background There is little information on medication use, trends across time, and the impact of guidelines on appropriate use of antidiabetic drugs in participants with type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD). Methods A cross‐sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2005‐2016 was carried out for participants with T2DM with and without CKD. Multivariate survey‐weighted regression models were used to evaluate trends in antidiabetic drug use across the time periods and CKD severity. Guideline‐discordant use of metformin and glyburide were assessed among those with glomerular filtration rate and serum creatinine‐based contraindications. Results Out of 3237 study participants with T2DM, 35.9% had CKD. Comparing 2013‐2016 with 2005‐2008, use of metformin (non‐CKD: 69% vs 83.8%, CKD: 58.6% vs 68.2%) increased, whereas the use of sulfonylureas (non‐CKD: 46.3% vs 27.2%, CKD: 54.7% vs 36.6%) and thiazolidinediones (non‐CKD: 29.3% vs 3.9%, CKD: 24.6% vs 5.5%) decreased. In combined NHANES cycles and across stages of CKD severity, metformin use decreased (non‐CKD, stage 1/2, stage 3, stage 4/5: 78.4%, 69.5%, 54.6%, 4.9%, respectively; P < .01), and insulin use increased (18.5%, 26.8%, 25%, 52.8%, respectively; P < .01) from non‐CKD to progressed CKD. Guideline‐discordant use of metformin and glyburide was observed in 8.3% and 2.8% of the participants, respectively, in 2013‐2016. Conclusions Use of particular antidiabetic medications in patients with CKD changed noticeably over the years, most in accordance with guidelines and regulatory decisions. Gaps in quality of care still exist, which warrants increasing awareness and implementing programs to mitigate inappropriate use.