Back to Journals » Vascular Health and Risk Management » Volume 10

How are patients with type 2 diabetes and renal disease monitored and managed? Insights from the observational OREDIA study

Authors Penfornis A, Blicklé JF, Fiquet B, Quéré S, Dejager S

Received 17 January 2014

Accepted for publication 18 March 2014

Published 13 June 2014 Volume 2014:10 Pages 341—352

DOI https://doi.org/10.2147/VHRM.S60312

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Alfred Penfornis,1 Jean Frédéric Blicklé,2 Béatrice Fiquet,3 Stéphane Quéré,4 Sylvie Dejager3

1Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean Minjoz Hospital, University of Franche-Comté, Besançon, France; 2Department of Internal Medicine and Diabetology, Strasbourg University Hospital, Strasbourg, France; 3Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France; 4BioStatistics, Novartis Pharma SAS, Rueil-Malmaison, France

Background and aim: Chronic kidney disease (CKD) is frequent in type 2 diabetes mellitus (T2DM), and therapeutic management of diabetes is more challenging in patients with renal impairment (RI). The place of metformin is of particular interest since most scientific societies now recommend using half the dosage in moderate RI and abstaining from use in severe RI, while the classic contraindication with RI has not been removed from the label. This study aimed to assess the therapeutic management, in particular the use of metformin, of T2DM patients with CKD in real life.
Methods: This was a French cross-sectional observational study: 3,704 patients with T2DM diagnosed for over 1 year and pharmacologically treated were recruited in two cohorts (two-thirds were considered to have renal disease [CKD patients] and one-third were not [non-CKD patients]) by 968 physicians (81% general practitioners) in 2012.
Results: CKD versus non-CKD patients were significantly older with longer diabetes history, more diabetic complications, and less strict glycemic control (mean glycated hemoglobin [HbA1c] 7.5% versus 7.1%; 25% of CKD patients had HbA1c ≥8% versus 15% of non-CKD patients). Fifteen percent of CKD patients had severe RI, and 66% moderate RI. Therapeutic management of T2DM was clearly distinct in CKD, with less use of metformin (62% versus 86%) but at similar mean daily doses (~2 g/d). Of patients with severe RI, 33% were still treated with metformin, at similar doses. For other oral anti-diabetics, a distinct pattern of use was seen across renal function (RF): use of sulfonylureas (32%, 31%, and 20% in normal RF, moderate RI, and severe RI, respectively) and DPP4-i (dipeptidyl peptidase-4 inhibitors) (41%, 36%, and 25%, respectively) decreased with RF, while that of glinides increased (8%, 14%, and 18%, respectively). CKD patients were more frequently treated with insulin (40% versus 16% of non-CKD patients), and use of insulin increased with deterioration of RF (19%, 39%, and 61% of patients with normal RF, moderate RI, and severe RI, respectively). Treatment was modified at the end of the study-visit in 34% of CKD patients, primarily to stop or reduce metformin. However, metformin was stopped in only 40% of the severe RI patients.
Conclusion: Despite a fairly good detection of CKD in patients with T2DM, RI was insufficiently taken into account for adjusting anti-diabetic treatment.

Keywords: therapeutic management, metformin, sulfonylureas, renal disease, type 2 diabetes


Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Readers of this article also read:

Optimal delivery of male breast cancer follow-up care: improving outcomes

Ferzoco RM, Ruddy KJ

Breast Cancer: Targets and Therapy 2015, 7:371-379

Published Date: 23 November 2015

Advances in cancer pain from bone metastasis

Zhu XC, Zhang JL, Ge CT, Yu YY, Wang P, Yuan TF, Fu CY

Drug Design, Development and Therapy 2015, 9:4239-4245

Published Date: 18 August 2015

Targeting the hypoxia pathway to treat pancreatic cancer

Erickson LA, Highsmith Jr WE, Fei P, Zhang J

Drug Design, Development and Therapy 2015, 9:2029-2031

Published Date: 8 April 2015

Clinical epidemiology of epithelial ovarian cancer in the UK

Doufekas K, Olaitan A

International Journal of Women's Health 2014, 6:537-545

Published Date: 23 May 2014

Update of research on the role of EZH2 in cancer progression

Shen L, Cui J, Liang S, Pang Y, Liu P

OncoTargets and Therapy 2013, 6:321-324

Published Date: 4 April 2013