TY  - JOUR
A1  - Busch, Martin
A1  - Nadal, Jennifer
A1  - Schmid, Matthias
A1  - Paul, Katharina
A1  - Titze, Stephanie
A1  - Hübner, Silvia
A1  - Köttgen, Anna
A1  - Schultheiss, Ulla T.
A1  - Baid-Agrawal, Seema
A1  - Lorenzen, Johan
A1  - Schlieper, Georg
A1  - Sommerer, Claudia
A1  - Krane, Vera
A1  - Hilge, Robert
A1  - Kielstein, Jan T.
A1  - Kronenberg, Florian
A1  - Wanner, Christoph
A1  - Eckardt, Kai-Uwe
A1  - Wolf, Gunter
T1  - 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
JF  - BMC Nephrology
N2  - 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 % (25th–75th 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.
KW  - Chronic kidney disease
KW  - Glycaemic control
KW  - Hemoglobin A1C
KW  - Insulin therapy
KW  - Oral antidiabetic drugs
KW  - Diabetes mellitus
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-164687
VL  - 17
IS  - 59
ER  -