Antidiabetic and Other Therapies Used in Subjects with Diabetes and Chronic Kidney Disease in a Hospital-Based Clinic Population in Greece.

Nikolaos Papanas,Athanasios E Raptis,Ioannis M Ioannidis,On Behalf Of The Hellenic Diabetic Nephropathy Study Hdns ,Ilias N Migdalis,Alexios E Sotiropoulos,George D Dimitriadis

doi:10.3390/jcm10102104

Abstract

(1) Background: Type 2 diabetes mellitus (T2DM) is the main cause of chronic kidney disease (CKD). In Greece, in a population from hospital-based diabetes clinics (n = 1759), the overall prevalence of diabetic chronic kidney disease (DCKD) was 45% including mild, moderate, and severe CKD. The aim of this study was to describe and analyze how T2DM patients with mild-to-severe CKD are managed by diabetologists in Greece and assess the achievement rates in glycemic, blood pressure and low-density lipoprotein-cholesterol (LDL-C) control. (2) Methods: This cross-sectional multicenter study took place from June 2015 to March 2016 and collected data from diabetes centers in public hospitals all over Greece. (3) Results: With regard to the anti-diabetes treatment, most participants were on metformin, DPP-4 (Dipeptidyl Peptidase-4 inhibitors) inhibitors and insulin. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were the most prescribed medications for hypertension. For the management of dyslipidemia, most participants were on statins. For patients with DCKD, the levels of HbA1c, blood pressure and LDL-C were 7.2%, 137.7/76.9 mmHg and 95.9 mg/dL, respectively (mean values). (4) Conclusions: The outcomes of this study suggest that management of DCKD can be further improved and should be enhanced. These results may contribute to the whole health care system in Greece. In addition, the better understanding of therapeutic strategies used by diabetologists treating these patients offers educational benefits to primary care physicians, which can result in an overall more successful and efficient management of subjects with T2DM and DCKD.

Highlights

Worldwide studies show that chronic kidney disease (CKD) is a leading cause of end-stage renal disease (ESRD) in type 2 diabetes mellitus (T2DM), which increases cardiovascular mortality [1]
The overall prevalence of diabetic chronic kidney disease (DCKD) was 45% distributed to stages from mild to severe with mean CKD duration 4.1 years
Patients with DCKD compared with patients without DCKD had higher mean age

Summary

Introduction

There is still some uncertainty on the true benefits of tight glycemic control on CKD progression, but antidiabetic, antihypertensive and hypolipidemic treatment remains the cornerstone of management [3,4]. Within this context, the choice of suitable therapeutic agents and their use in clinical practice is still a matter of worldwide interest. The present study was designed to examine which antidiabetic, antihypertensive and hypolipidemic agents are used in subjects with diabetes and CKD in Greece, looking at a hospital-based clinic population. The findings could be useful for non-specialists and general practitioners since gradual deterioration of kidney function is an important comorbidity to be considered when selecting antidiabetic agents

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