Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study

Abstract Background Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Since these publications, a number of new medications have become availabl...

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Main Authors: Jo-Anne Manski-Nankervis, Sharmala Thuraisingam, Janet K. Sluggett, Gary Kilov, John Furler, David O’Neal, Alicia Jenkins
Format: Article
Language:English
Published: BMC 2019-02-01
Series:BMC Family Practice
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12875-019-0915-x
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author Jo-Anne Manski-Nankervis
Sharmala Thuraisingam
Janet K. Sluggett
Gary Kilov
John Furler
David O’Neal
Alicia Jenkins
author_facet Jo-Anne Manski-Nankervis
Sharmala Thuraisingam
Janet K. Sluggett
Gary Kilov
John Furler
David O’Neal
Alicia Jenkins
author_sort Jo-Anne Manski-Nankervis
collection DOAJ
description Abstract Background Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Since these publications, a number of new medications have become available for the management of T2D. Study aims were to, in a cohort of Australians with T2D and renal impairment attending general practice, (1) investigate whether the prescribing of non-insulin diabetes medications is consistent with dosing adjustments recommended within current Australian Diabetes Society (ADS) guidelines; and (2) identify patient socio-demographic and clinical factors associated with at least one prescription of a non-insulin diabetes medication inconsistent with current ADS guidelines for medication doses. Methods Cross-sectional study using data from the MedicineInsight general practice database managed by NPS MedicineWise. Patients with T2D who were aged 18 years and over, with an average eGFR< 60 ml/min/1.73m2 and at least one prescription of a non-insulin diabetes medication between 1st January 2015 and 30th June 2017 were included. Descriptive statistics were used to summarise patient characteristics and medication use. Marginal logistic regression models were used to estimate associations between sociodemographic and clinical factors and prescribing of ≥1non-insulin diabetes medicine not consistent with ADS guidelines. Results The majority of the 3505 patients included (90.4%) had an average eGFR of 30-59 ml/min/1.73m2. In terms of absolute numbers, metformin was the medication most frequently prescribed at a dose not consistent with current ADS guidelines for dosing in renal impairment (n = 1601 patients), followed by DPP4 inhibitors (n = 611) and sulphonylureas (n = 278). The drug classes with the highest proportion of prescriptions with dosage not consistent with ADS guidelines were SGLT2 inhibitors (83%), followed by biguanides (58%) and DPP4 inhibitors (46%). Higher HbA1c, longer known diabetes duration and diagnosis of retinopathy were associated with receiving ≥1prescription with a dosage not consistent with guidelines. Conclusions Prescribing of non-insulin diabetes medications at doses inconsistent with current ADS guideline recommendations for dosing adjustments for people with renal impairment was common. Further research is needed to understand how general practitioners access, interpret and apply the ADS guidelines and the impact this may have on patient outcomes.
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spelling doaj.art-cae3a2aad7874090adf207c4fe99c5da2022-12-22T02:47:54ZengBMCBMC Family Practice1471-22962019-02-0120111110.1186/s12875-019-0915-xPrescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional studyJo-Anne Manski-Nankervis0Sharmala Thuraisingam1Janet K. Sluggett2Gary Kilov3John Furler4David O’Neal5Alicia Jenkins6Department of General Practice, University of MelbourneDepartment of General Practice, University of MelbourneCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash UniversityDepartment of General Practice, University of MelbourneDepartment of General Practice, University of MelbourneDepartment of Medicine, St Vincent’s Hospital and University of MelbourneDepartment of Medicine, St Vincent’s Hospital and University of MelbourneAbstract Background Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Since these publications, a number of new medications have become available for the management of T2D. Study aims were to, in a cohort of Australians with T2D and renal impairment attending general practice, (1) investigate whether the prescribing of non-insulin diabetes medications is consistent with dosing adjustments recommended within current Australian Diabetes Society (ADS) guidelines; and (2) identify patient socio-demographic and clinical factors associated with at least one prescription of a non-insulin diabetes medication inconsistent with current ADS guidelines for medication doses. Methods Cross-sectional study using data from the MedicineInsight general practice database managed by NPS MedicineWise. Patients with T2D who were aged 18 years and over, with an average eGFR< 60 ml/min/1.73m2 and at least one prescription of a non-insulin diabetes medication between 1st January 2015 and 30th June 2017 were included. Descriptive statistics were used to summarise patient characteristics and medication use. Marginal logistic regression models were used to estimate associations between sociodemographic and clinical factors and prescribing of ≥1non-insulin diabetes medicine not consistent with ADS guidelines. Results The majority of the 3505 patients included (90.4%) had an average eGFR of 30-59 ml/min/1.73m2. In terms of absolute numbers, metformin was the medication most frequently prescribed at a dose not consistent with current ADS guidelines for dosing in renal impairment (n = 1601 patients), followed by DPP4 inhibitors (n = 611) and sulphonylureas (n = 278). The drug classes with the highest proportion of prescriptions with dosage not consistent with ADS guidelines were SGLT2 inhibitors (83%), followed by biguanides (58%) and DPP4 inhibitors (46%). Higher HbA1c, longer known diabetes duration and diagnosis of retinopathy were associated with receiving ≥1prescription with a dosage not consistent with guidelines. Conclusions Prescribing of non-insulin diabetes medications at doses inconsistent with current ADS guideline recommendations for dosing adjustments for people with renal impairment was common. Further research is needed to understand how general practitioners access, interpret and apply the ADS guidelines and the impact this may have on patient outcomes.http://link.springer.com/article/10.1186/s12875-019-0915-xType 2 diabetesRenal impairmentChronic kidney diseasePrescribingGuidelinesAnti-diabetes medications
spellingShingle Jo-Anne Manski-Nankervis
Sharmala Thuraisingam
Janet K. Sluggett
Gary Kilov
John Furler
David O’Neal
Alicia Jenkins
Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study
BMC Family Practice
Type 2 diabetes
Renal impairment
Chronic kidney disease
Prescribing
Guidelines
Anti-diabetes medications
title Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study
title_full Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study
title_fullStr Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study
title_full_unstemmed Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study
title_short Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease: a national cross-sectional study
title_sort prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease a national cross sectional study
topic Type 2 diabetes
Renal impairment
Chronic kidney disease
Prescribing
Guidelines
Anti-diabetes medications
url http://link.springer.com/article/10.1186/s12875-019-0915-x
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