Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort

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Background:
Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD.

Methods:
The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18–74 years with an estimated glomerular filtration rate (eGFR) between 30–60 mL/min/1.73 m² or proteinuria >0.5 g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure.

Results:
At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25^th–75^th percentile: 6.8–7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral antidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was used by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase of 1 kg/m², 95 % CI 1.02–1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04–1.18), treatment with insulin alone (OR = 5.63, 95 % CI 4.26–7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77–6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides.

Conclusions:
Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels.

Keywords:
Chronic kidney disease, Diabetes mellitus, Glycaemic control, Hemoglobin A1C, Insulin therapy, Oral antidiabetic drugs

Autoři: Martin Busch ^1*; Jennifer Nadal ²; Matthias Schmid ²; Katharina Paul ¹; Stephanie Titze ³; Silvia Hübner ³; Anna Köttgen ⁴; Ulla T. Schultheiss ⁴; Seema Baid-Agrawal ⁵; Johan Lorenzen ⁶; Georg Schlieper ⁷; Claudia Sommerer ⁸; Vera Krane ⁹; Robert Hilge ¹⁰; Jan T. Kielstein ⁶; Florian Kronenberg ¹¹; Christoph Wanner ⁹; Kai-Uwe Eckardt ³; Gunter Wolf ¹; And On Behalf Of The Gckd Study Investigators
Působiště autorů: Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 1, D – 077 Jena, Germany. ¹; Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany. ²; Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany. ³; Department of Internal Medicine IV, Medical Center University of Freiburg, Freiburg, Germany. ⁴; Department of Medicine, Division of Nephrology and Medical Intensive Care, University Hospital Charité, Berlin, Germany. ⁵; Hannover Medical School, Clinic for Nephrology, Hannover, Germany. ⁶; Department of Medicine II - Nephrology and Clinical Immunology, University Hospital Aachen, Aachen, Germany. ⁷; Department of Medicine, Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany. ⁸; Department of Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany. ⁹; Department of Medicine IV, Division of Nephrology, University Hospital of Ludwig-Maximilians University Munich, Munich, Germany. ¹⁰; Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria. ¹¹
Vyšlo v časopise: BMC Nefrol 2016, 17:59
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12882-016-0273-z

© The Author(s). 2016
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0273-z

Souhrn

Keywords:
Chronic kidney disease, Diabetes mellitus, Glycaemic control, Hemoglobin A1C, Insulin therapy, Oral antidiabetic drugs

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