Abstract
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.
Highlights
Diabetes has been estimated to account for approximately 1.5 million deaths in 2012, with more than 80% of diabetes-related deaths in low- and middle-income countries [1]
Systolic blood pressure (BP) and antihypertensive treatment rate increased with age, while the percentage of current smokers decreased
It is worth noting that mean HbA1c was 7.1% in patients in the fourth quartile, indicating that almost half of patients within this class had HbA1c values below 7.0% and were, very likely, overtreated
Summary
Diabetes has been estimated to account for approximately 1.5 million deaths in 2012, with more than 80% of diabetes-related deaths in low- and middle-income countries [1]. Lifestyle modification and glucose-lowering drug treatment are the mainstay of therapy to prevent and delay diabetes-related complications [2,3]. While the cardiovascular benefits associated to the use of metformin have been described, a careful assessment of kidney function is necessary prior to prescribe this drug as it is primarily eliminated via the kidney [7]. Limitations on the use of this drug in individuals with mild or moderate impairment of renal function have been disputed [8,9,10], because of poor evidence on a specific safety threshold and the lack of clear-cut evidence supporting increased risk of complications (especially lactic acidosis) in the presence of mild or moderate renal impairment. It is agreed upon that this drug should not be used in the presence of severe kidney dysfunction, i.e. GFR below 30 ml/min/1.73m2 [2,3]
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