Abstract
IntroductionThe study characterizes the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) with and without renal impairment and examines the effects of such use on the clinical outcomes of estimated glomerular filtration rate (eGFR) and glycated hemoglobin (A1c).MethodsData from the Practice Fusion electronic health records database from 1 January 2012 through 30 April 2015 were used. Adults with T2D who received serum creatinine laboratory tests and initiated therapy with a GLP-1 RA (N = 3225) or other glucose-lowering agent (GLA) (N = 37,074) were included in the analysis. The GLP-1 RA cohort was matched to cohorts initiating therapy any other GLA, and multivariable analyses examined the association between GLP-1 RA use and changes in eGFR or A1c at 1 year after therapy initiation.ResultsIn this study, only 5.7% of patients with an eGFR of < 30 and ≥ 15 mL/min/1.73 m2 and 3.6% of patients with an eGFR of < 15 mL/min/1.73 m2 initiated therapy with a GLP-1 RA. Compared to other GLAs, at 1-year after initiation of therapy the use of a GLP-1 RA was associated with a significantly smaller decline in eGFR (− 0.80 vs. − 1.03 mL/min/1.73 m2; P = 0.0005), a significantly smaller likelihood of having a ≥ 30% reduction in eGFR (2.19 vs. 3.14%; P < 0.0001), and a significantly larger reduction in A1c (− 0.48 vs. − 0.43; P = 0.0064).ConclusionIn clinical practice, the use of GLP-1 RAs in patients with a higher degree of renal impairment disease was limited. Compared to other GLAs, the use of GLP-1 RAs was associated with a significantly smaller decline in eGFR and a larger reduction in A1c over the 1 year following therapy initiation.FundingEli Lilly and Company.
Highlights
The study characterizes the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) with and without renal impairment and examines the effects of such use on the clinical outcomes of estimated glomerular filtration rate and glycated hemoglobin (A1c)
To investigate how GLP-1 RAs are being prescribed in real-world settings, we have examined the frequency of initiation on drugs in this class across various estimated glomerular filtration rate categories in patients with
Examination of differences in pre-period general health, comorbidities, glucose-lowering agent (GLA) use, other medication use, and visits to specialists generally suggested that patients who initiated therapy with a GLP-1 RA were in poorer health than patients who initiated therapy with other GLAs
Summary
The study characterizes the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) with and without renal impairment and examines the effects of such use on the clinical outcomes of estimated glomerular filtration rate (eGFR) and glycated hemoglobin (A1c). Chronic kidney disease (CKD) is a common type 2 diabetes (T2D) complication that is associated with an increased risk of adverse outcomes [1]. The U.S Renal Data System attributed diabetes as the primary cause of endstage renal disease (ESRD) in 44.3% of incident dialysis patients in 2011 [2], and patients with comorbid T2D and CKD have been reported to experience increased rates of cardiovascular morbidity and mortality [3]. The U.S Food Drug Administration (FDA) label for GLP-1 RA exenatide states that the drug ‘‘should not be used in patients with severe renal impairment or end-stage renal disease and should be used with caution in patients with renal transplantations’’ [12], and the FDA’s label for lixisenatide recommends monitoring of renal function when initiating or escalating doses of the drug and states that the drug ‘‘is not recommended in patients with end stage renal disease’’ [13]
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