Prescribing for people with type 2 diabetes and renal impairment in Australian general practice: A national cross sectional study.

AIM

To determine whether the prescribing of non-insulin anti-hyperglycaemic medications in Australian general practice is consistent with current guidelines for treatment of type 2 diabetes (T2D) in people with renal impairment.

METHODS

Cross-sectional study of 9624 people with T2D in the NPS MedicineInsight dataset aged≥18years with average estimated glomerular filtration rate (eGFR) <60ml/min/1.73m and prescribed at least one non-insulin anti-hyperglycaemic medication from October 2014 to September 2015. The primary outcome was the proportion of non-insulin anti-hyperglycaemic medications prescribed at doses inconsistent with current guidelines.

RESULTS

4650 (48.3%) patients were prescribed at least one non-insulin anti-hyperglycaemic medication at a dose inconsistent with Australian Diabetes Society guidelines. The majority (88.0%) had an average eGFR of 30-59ml/min/1.73m. Metformin was the most frequently prescribed agent (n=7408; 77.0%), and was prescribed at a dose inconsistent with guidelines for 52% of patients. 123/136 (90.5%) people prescribed a sodium glucose co-transporter 2 inhibitor and 1114/2194 (50.8%) prescribed a dipeptidyl peptidase-4 inhibitor were prescribed a dose inconsistent with guidelines. Decreasing age, being male or being on insulin was associated with greater odds of at least one prescription inconsistent with guidelines.

CONCLUSION

Nearly half of people with T2D and renal impairment were prescribed a non-insulin anti-hyperglycaemic medication at a dose inconsistent with current Australian guidelines, the majority of whom had an eGFR consistent with stage 3 chronic kidney disease.