Quality of diabetes mellitus therapy in patients with chronic kidney disease in the real world

  • Beatrice Giampietro Department of Internal Medicine, Santo Spirito Hospital, Roma, Italy.
  • Fabrizio Tiratterra | f.tiratterra@virgilio.it Department of Internal Medicine, Santo Spirito Hospital, Roma, Italy.
  • Antonella Paradiso Department of Internal Medicine, S. Eugenio Hospital, Roma, Italy.
  • Fabiana Lanti Department of Internal Medicine, Nuovo Regina Margherita Hospital, Roma, Italy.
  • Chiara Villani Department of Internal Medicine, Santo Spirito Hospital, Roma, Italy.
  • Umberto Recine Department of Internal Medicine, Santo Spirito Hospital, Roma, Italy.

Abstract

Chronic kidney disease (CKD) is very often among diabetic patients. Some oral antidiabetic agents are not recommended in the presence of CKD. Aim of the study was to evaluate the quality of diabetes mellitus (DM) treatment in nephrophatic patients in the real world. A total of 265 subjects with type 2 DM, consecutively admitted to the internal medicine departments of two hospitals in Rome, were recruited. Patients hospitalized for hypoglycemia, decompensated DM, acute kidney failure or worsening nephropathy were excluded. For each patient, the following data were collected: age, gender, estimated glomerular filtration rate (eGFR) using the MDRD (modification of diet in renal disease) study equation, type of antidiabetic drug treatment. A total of 265 subjects were studied, 127 male (47.9%) and 138 female (52.1%). The mean age was 77.5 years. The mean of glycemia glycated hemoglobin (HbA1c) value was 57.5 mmol/mol (7.4%). 137 patients (51.7%) were treated with oral antidiabetic agents, 29 (10%) with both oral antidiabetic agents and insulin, 90 (34%) with insulin alone, 8 (3%) with dipeptidyl peptidase-4 inhibitors, 1 (0.4%) with incretin agents plus oral antidiabetic drugs. According to the Kidney Disease Outcomes Quality Initiative (KDOQI) classification of CKD, the sample was divided into 5 groups using eGFR criteria. For each group, mean HbA1c values, type of antidiabetic treatment, appropriateness of therapy according to guidelines and how it may affect the HbA1c levels were considered. Our data show that 30.5% of patients with CKD stage 3-5 is treated with drugs not recommended by current guidelines.

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Published
2017-03-15
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Original Articles
Keywords:
Diabetes mellitus, chronic kidney disease, hypoglycemic agents, elderly.
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How to Cite
Giampietro, B., Tiratterra, F., Paradiso, A., Lanti, F., Villani, C., & Recine, U. (2017). Quality of diabetes mellitus therapy in patients with chronic kidney disease in the real world. Italian Journal of Medicine, 11(1), 48-51. https://doi.org/10.4081/itjm.2017.726