Type 2 Diabetes Mellitus and Renal Impairment in Real-World with Large Outpatient Electronic Medical Records—Antihyperglycemic Medication Dose Adjustment

Abstract

Objective: To estimate the level of inappropriate dosing of DPP-4 inhibitors, and to assess the level of emergency room visits, hypoglycemia, and mortality according to inappropriate dosing of DPP-4 inhibitors in type 2 diabetes (T2DM) patients with renal impairment(RI). Research Design and Methods: Retrospective database analysis using the National Health Insurance Service Database and the General Health Examination Database in Korea. Patients aged ≥ 40 years with evidence of T2DM (ICD-9-CM codes from E10.x-E14.x) January 1, 2009 to December 31, 2015. Renal impairment defined with estimated with the Modification of Diet in Renal Disease [MDRD] GFR equation. To estimate the level of inappropriate dosing of DPP-4 inhibitors in RI was according to daily prescribed dose. And The incidence of emergency room visits, hypoglycemia, and mortality were assessed using the hazard ratios (HRs) estimated with logistic regression model. Results: In our study, we analysis 161,760 patients with T2DM and RI. Among them DPP-4 inhibitors were prescribed to 44232 patients (27.3%). DPP-4 inhibitor prescribed 21.44% in GFR<30 and 32.28% in 30≤GFR<50. In observation period, percentages of inappropriate dosing of DPP-4 inhibitors in T2DM with RI was 31.9%. The age and sex adjusted HR with 95% confidence interval (CI) for appropriate dosing of DPP-4 inhibitors compared with inappropriate dosing of DPP-4 inhibitors was 0.871(0.842,0.9) for emergency room visits, 0.819(0.748,0.898) for sever hypoglycemia, and 0.775(0.717,0.839) for mortality. Conclusions: Renal impairment is common but often undetected in patients with T2DM. In Korea, one of three patients with T2DM and RI received inappropriate doses, and they were associated with high risk of emergency room visits and sever hypoglycemia, and higher mortality. Further analyses to understand the clinical and economic consequences of these findings are needed. Disclosure S. Hong: None. C. Park: None.