Trifirò Gianluca, Parrino Fabrizio, Pizzimenti Valeria, Giorgianni Francesco, Sultana Janet, Muscianisi Marco, Troncone Chiara, Tari Daniele U, Arcoraci Vincenzo, Santoro Domenico, Russo Giusi, Lacava Viviana, Caputi Achille P
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
Clin Drug Investig. 2016 Mar;36(3):203-12. doi: 10.1007/s40261-015-0367-6.
Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antidiabetic drug use in DKD patients from Southern Italy.
The Arianna database from Caserta Local Health Unit was used. Diabetic patients with incident CKD [first diagnosis date: index date (ID)] were identified by searching for specific ICD9-CM codes among hospital discharge diagnoses/procedures and/or indication of use associated with drug prescriptions. To evaluate any change in the use of antidiabetic drugs after the CKD diagnosis, the prevalence of antidiabetic drug use among DKD patients was calculated within 1 year prior to/after ID and after dialysis entry. A Kaplan-Meier analysis was used to assess the time to discontinuation of antidiabetic drugs after CKD diagnosis. The frequency of antidiabetic drugs contraindicated in renal disease in DKD patients was measured.
Overall, 725 diabetic patients (mean age 72.8 ± 11.4 years) had incident CKD from 2006 to 2011. The use of combination antidiabetic drugs, biguanides and sulphonamides decreased by approximately 10, 7 and 5%, respectively, after the ID. The use of insulins increased by 10% after the ID and by 20% after entry into dialysis. The use of antidiabetic drugs not contraindicated in CKD decreased marginally after the diagnosis of CKD.
In a general practice of Southern Italy the management of diabetes mellitus changed only marginally in newly diagnosed CKD patients, suggesting a therapeutic inertia on the part of prescribers.
慢性肾脏病（CKD）患者的糖尿病被称为糖尿病肾病（DKD）。由于一些抗糖尿病药物的肾脏排泄减少，DKD的药物治疗具有挑战性。这项基于人群的研究旨在探索意大利南部DKD患者的抗糖尿病药物使用情况。
使用卡塞塔地方卫生单位的阿丽亚娜数据库。通过在医院出院诊断/程序和/或与药物处方相关的使用指征中搜索特定的ICD9-CM编码，识别出患有新发CKD的糖尿病患者[首次诊断日期：索引日期（ID）]。为了评估CKD诊断后抗糖尿病药物使用的任何变化，计算了DKD患者在ID之前/之后1年内以及开始透析后的抗糖尿病药物使用患病率。采用Kaplan-Meier分析评估CKD诊断后停用抗糖尿病药物的时间。测量了DKD患者中肾病禁用的抗糖尿病药物的使用频率。
总体而言，2006年至2011年期间有725例糖尿病患者（平均年龄72.8±11.4岁）患有新发CKD。ID后，联合使用抗糖尿病药物、双胍类药物和磺酰胺类药物的使用分别下降了约10%、7%和5%。ID后胰岛素的使用增加了10%，透析开始后增加了20%。CKD诊断后，CKD不禁用的抗糖尿病药物的使用略有下降。
在意大利南部的一般医疗实践中，新诊断的CKD患者的糖尿病管理仅略有变化，这表明处方者存在治疗惰性。
