Min Thinzar, Davies Gareth I, Rice Sam, Chess James, Stephens Jeffrey W
Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 8NL, UK; Diabetes Research Group, School of Medicine, Swansea University, Swansea, SA2 8PP, UK.
Data Science, Swansea University, Swansea, SA2 8PP, UK.
Diabetes Metab Syndr. 2018 Apr-Jun;12(2):123-127. doi: 10.1016/j.dsx.2017.11.002. Epub 2017 Nov 23.
Chronic kidney disease (CKD) is common in type 2 diabetes and limits the treatment choices for glycaemic control. Our aim was to examine real-world prescribing for managing hyperglycaemia in the presence of CKD.
The SAIL (Secure Anonymised Information Linkage) databank was used to examine prescribing during the period from the 1st of January to 30th December 2014. CKD was defined as:- none or mild CKD, eGFR ≥60mL/min/1.73m; moderate CKD eGFR <60mL/min/1.73m; and severe CKD eGFR <30mL/min/1.73m or requiring dialysis.
We identified 9585 subjects who received any form of glucose lowering therapy (8363 had no/mild CKD; 1137 moderate CKD; 85 severe CKD). There was a linear association between insulin use and CKD severity with approximately 54% of those with severe CKD receiving insulin. Sulphonylureas use did not differ among the CKD groups and was approximately 40%. Metformin showed a linear decrease across the groups, however approximately 21% in the severe CKD group received metformin. The use of dipeptidyl peptidase 4 inhibitors (DPP-4i) was approximately 20% and did not differ among groups. The DPP-4 inhibitor choice was:- 1% vildagliptin, 9% saxagliptin, 58% sitagliptin, and 32% linaglitpin. With respect to sitagliptin and saxagliptin, 72% and 62% received an inappropriately high dose in the setting of CKD.
We observed that a considerable proportion of patients with type 2 diabetes and CKD were receiving metformin and non dose-adjusted DPP-4 inhibitors. Careful consideration of medication use and dosaging is required in the setting of CKD and type 2 diabetes.
慢性肾脏病（CKD）在2型糖尿病中很常见，并且限制了血糖控制的治疗选择。我们的目的是研究在存在CKD的情况下治疗高血糖的实际处方情况。
使用SAIL（安全匿名信息链接）数据库来研究2014年1月1日至12月31日期间的处方情况。CKD的定义为：无或轻度CKD，估算肾小球滤过率（eGFR）≥60mL/（min·1.73m²）；中度CKD，eGFR＜60mL/（min·1.73m²）；重度CKD，eGFR＜30mL/（min·1.73m²）或需要透析。
我们确定了9585名接受任何形式降糖治疗的受试者（8363名无/轻度CKD；1137名中度CKD；85名重度CKD）。胰岛素使用与CKD严重程度之间存在线性关联，重度CKD患者中约54%接受胰岛素治疗。磺脲类药物的使用在CKD各亚组间无差异，约为40%。二甲双胍的使用在各亚组中呈线性下降，但重度CKD组中约21%的患者使用二甲双胍。二肽基肽酶4抑制剂（DPP-4i）的使用率约为20%，各亚组间无差异。DPP-4抑制剂的选择为：维格列汀1%，沙格列汀9%，西格列汀58%，利奈格列汀32%。就西格列汀和沙格列汀而言，72%和62%的患者在CKD情况下接受了不适当的高剂量治疗。
我们观察到相当一部分2型糖尿病合并CKD的患者正在接受二甲双胍和未调整剂量的DPP-4抑制剂治疗。在CKD和2型糖尿病患者中，需要仔细考虑药物的使用和剂量。
