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
نویسندگان
چکیده
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 m(2) 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/m(2), 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.
منابع مشابه
Proposed Method for Predicting COVID-19 Severity in Chronic Kidney Disease Patients Based on Ant Colony Algorithm and CHAID
Background and Objective: The COVID-19 pandemic is a phenomenon that has infected and killed many people worldwide. Underlying diseases such as diabetes mellitus, heart failure, and chronic kidney disease (CKD) can affect the severity of COVID-19 and aggravate patients' condition. This study aimed to predict the severity of the COVID-19 disease in CKD patients by combining feature selection and...
متن کاملPrediction of chronic kidney disease in Isfahan with extracting association rules using data mining techniques
Background: Millions of deaths occur around the world each year due to lack of access to appropriate treatment for chronic kidney disease patients. Given the importance and mortality rate of this disease, early and low-cost prediction is very important. The researchers intend to identify chronic kidney disease through the optimal combination of techniques used in different stages of data mining...
متن کاملImmunosuppressive Drugs and Kidney Post-transplant Diabetes Mellitus
Background: As the rate of renal transplantation increases, more immunosuppressive drugs such as cyclosporine A (CsA) are consumed, particularly during the early months following transplantation, leading to post-transplant diabetes mellitus (PTDM) which can cause death. Objective: The present study examined the role of CsA in causing PTDM and other effect...
متن کاملPrevalence and Risk Factors for Chronic Kidney Disease in Family Relatives of a Cameroonian Population of Hemodialysis Patients: A Cross-Sectional Study
Background: In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for C...
متن کاملSeroprevalence of Hepatitis B and C Virus Infection in Children with Chronic Kidney Diseases; A Historical Cohort Study
Background: The prevalence of hepatitis B and C in Iranian children with chronic kidney disease is limited. Therefore, the present study intends to assess the prevalence of hepatitis B and C in children with chronic kidney disease (CKD).Method: The present study is a historical cohort study which was conducted in a window period of 25 years in Children’s Medical Center in Tehran, 1991-2016. Dat...
متن کامل