Metformin utilisation in Australian community and aged care settings

Prescribing for people with type 2 diabetes and renal impairment in Australian general practice: A national cross sectional study

AIM

To determine whether the prescribing of non-insulin anti-hyperglycaemic medications in Australian general practice is consistent with current guidelines for treatment of type 2 diabetes (T2D) in people with renal impairment.

METHODS

Cross-sectional study of 9624 people with T2D in the NPS MedicineInsight dataset aged≥18years with average estimated glomerular filtration rate (eGFR) <60ml/min/1.73m² and prescribed at least one non-insulin anti-hyperglycaemic medication from October 2014 to September 2015. The primary outcome was the proportion of non-insulin anti-hyperglycaemic medications prescribed at doses inconsistent with current guidelines.

RESULTS

4650 (48.3%) patients were prescribed at least one non-insulin anti-hyperglycaemic medication at a dose inconsistent with Australian Diabetes Society guidelines. The majority (88.0%) had an average eGFR of 30-59ml/min/1.73m². Metformin was the most frequently prescribed agent (n=7408; 77.0%), and was prescribed at a dose inconsistent with guidelines for 52% of patients. 123/136 (90.5%) people prescribed a sodium glucose co-transporter 2 inhibitor and 1114/2194 (50.8%) prescribed a dipeptidyl peptidase-4 inhibitor were prescribed a dose inconsistent with guidelines. Decreasing age, being male or being on insulin was associated with greater odds of at least one prescription inconsistent with guidelines.

CONCLUSION

Nearly half of people with T2D and renal impairment were prescribed a non-insulin anti-hyperglycaemic medication at a dose inconsistent with current Australian guidelines, the majority of whom had an eGFR consistent with stage 3 chronic kidney disease.

Antihyperglycemic treatment in patients with type 2 diabetes in Italy: the impact of age and kidney function

We describe AHA utilization pattern according to age and renal function in type 2 diabetes mellitus (T2DM), in real-life conditions.

The analysis was performed using the data set of electronic medical records collected between 1 January and 31 December, 2011 in 207 Italian diabetes centers. The study population consisted of 157,595 individuals with T2DM. The AHA treatment regimens was evaluated. Kidney function was assessed by eGFR, estimated using the CKD-EPI formula. Other determinations: HbA1c, blood pressure (BP), low- density lipoprotein (LDL-c), total and high density lipoprotein cholesterol (TC and HDL-c), triglycerides (TG) and serum uric acid (SUA). Quality of care was assessed through Q score.

The proportion of subjects taking metformin declined progressively across age quartiles along with eGFR values, but remained high in oldest subjects (i.e. 54.5 %). On the other hand, the proportion of patients on secretagogues or insulin increased with aging (i.e. 54.7% and 37% in the fourth age quartile, respectively). The percentage of patients with low eGFR (i.e. <30 ml/min/1.73m2) taking either metformin or sulphonilureas/repaglinide was particularly high (i.e. 15.3% and 34.3% respectively).

In a large real-life cohort of T2DM, metformin or sulphonylureas/repaglinide, although not recommended, are frequently prescribed to elderly subjects with severe kidney disease.