Kidney Function Worsens With More Insulin, Fewer Antidiabetic Agents
Increased insulin use and decreased use of other antidiabetic treatments are associated with poor renal function in patients with type 2 diabetes with hyperglycemia, according to a recent study.
The risk of kidney dysfunction increases with age, prompting concerns regarding cardiovascular complications associated with expensive noninsulin agents for type 2 diabetes. Currently, no direct comparisons are available to guide the choice of new drugs for hyperglycemia among patients with type 2 diabetes, with a decreased estimated glomerular filtration rate (eGFR), and with increased cardiovascular risk.
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For their study, the researchers evaluated the prescriptions for 10,151 patients with type 2 diabetes and hypertension who had been seen 2 or more times at a single center from 2007 to 2012. Mean patient age was 64 years, mean body mass index was 31 kg/m2, and mean eGFR was 78 mL/min/1.73 m2.
Results indicated that more than 60% of patients had used insulin, 50% had used metformin, and 25% had used sulfonylurea derivatives. Furthermore, 10% of patients had been prescribed dipeptidyl peptidase 4 (DPP4) and acarbose class drugs, 8% had received glucagon-like peptide-1 (GLP-1) agonists, and less than 5% had taken other classes of drugs, including thiazolidinediones (TZD).
The researchers categorized patients as having received no medications (n = 447); insulin only (n = 3836), medications other than insulin (n = 2910), or insulin combinations (n = 2955). Ultimately, insulin/metformin (n = 2493), insulin/sulfonylureas (n = 706), metformin/sulfonylureas (n = 2017), metformin/GLP1 (n = 949), metformin/DPP4 (n = 895), and metformin/TZD (n = 500) were the most common treatment combinations.
Insulin use had increased from 35% to 70%, whereas eGFR had decreased to less than 30 mL/min/1.73 m2. Combined use of insulin with other drugs had decreased from 31% to 12%, and the use of other drugs alone without insulin had decreased from 30% to 12%.
“Reduced renal function was associated with increased use of insulin and decreased use of other anti-diabetic agents in a statistically significant progression,” the researchers concluded. “BMI and gender did not influence medication choice.”
—Christina Vogt
Reference:
Weinrauch LA, Segal AR, Bayliss GP, Liu J, Wisniewski E, D’Elia JA. Changes in treatment of hyperglycemia in a hypertensive type 2 diabetes population as renal function declines. Clin Kidney J. 2017;10(5):661-665. https://doi.org/10.1093/ckj/sfx020.