Metformin prescriptions, along with those for newer diabetes drugs, rose in people with diabetic kidney disease during a recent nine-year period, according to a study published in the journal Kidney Medicine.
The researchers’ goal was simply to learn more about what medications people with diabetes and chronic kidney disease are taking. They looked at a random sample of U.S. Medicare enrollees with both health conditions between 2007 and 2016, to see how the rate of various prescriptions changed during that period. They also looked at whether kidney disease stage, income status, and demographic factors including age, sex, race and ethnicity had any effect on what diabetes drugs people were prescribed.
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The researchers found that metformin prescriptions increased significantly, from 32.7% of participants in 2007 to 48.7% in 2016. Prescriptions for certain newer classes of diabetes drugs also increased during this period, including for DPP-4 inhibitors (from 5.6% to 21.7%), GLP-1 receptor agonists (from 2.3% to 6.1%), and SGLT2 inhibitors (from 0.2% to 3.3%). Use of newer insulin analogs also increased between 2007 and 2013 (from 32.7% to 48.7%) but leveled off after that. Use of many older types of diabetes drugs, including older forms of insulin, dropped significantly during the study period.
As noted in a Healio article on the study, the overall findings suggest that doctors are following updated guidelines on treating diabetes in people with chronic kidney disease. These guidelines state that for people with stage 3 or later kidney disease, metformin is the recommended first-line drug because of its safety, potential cardiovascular benefits, and low cost. SGLT2 inhibitors are also recommended for this population, with a GLP-1 receptor agonist frequently recommended if glucose still isn’t adequately under control.
Participants were less likely to receive combination therapy for their diabetes — two or more diabetes drugs of any kind — at later stages of kidney disease, for reasons that are unclear. Overall, insulin was the most commonly used diabetes drug in the study population, and its use in low-income people was greater among those who received a subsidy based on their income level. This finding reflects, no doubt, the high out-of-pocket costs often associated with insulin that may prevent its widespread use in many lower-income people who aren’t aware of or eligible for subsidies through Medicare Part D.
The researchers concluded that while many trends they found in the study were encouraging, further studies are needed to test the safety and effectiveness of different diabetes medications in people with chronic kidney disease. This is especially true in light of recent studies showing that SGLT2 inhibitors and GLP-1 receptor agonists may help slow kidney disease progression.
Want to learn more about keeping your kidneys healthy with diabetes? Read “How to Keep Your Kidneys Healthy,” “Kidney Disease: Your Seven-Step Plan for Prevention” and “Ten Things to Know About Kidney Disease.”
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