Manski-Nankervis Jo-Anne E, Thuraisingam Sharmala, Sluggett Janet K, Lau Phyllis, Blackberry Irene, Ilomaki Jenni, Furler John, Bell J Simon
Department of General Practice, University of Melbourne, Carlton, Australia.
Department of General Practice, University of Melbourne, Carlton, Australia.
Prim Care Diabetes. 2019 Apr;13(2):113-121. doi: 10.1016/j.pcd.2018.09.001. Epub 2018 Sep 24.
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.
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.
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.
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.
确定澳大利亚全科医疗中开具的非胰岛素类降糖药物的处方是否符合目前针对肾功能损害的2型糖尿病（T2D）患者的治疗指南。
对NPS MedicineInsight数据集中年龄≥18岁、平均估计肾小球滤过率（eGFR）<60ml/（min·1.73m²）且在2014年10月至2015年9月期间开具了至少一种非胰岛素类降糖药物的9624例T2D患者进行横断面研究。主要结局是开具的非胰岛素类降糖药物剂量不符合现行指南的比例。
4650例（48.3%）患者开具了至少一种剂量不符合澳大利亚糖尿病协会指南的非胰岛素类降糖药物。大多数（88.0%）患者的平均eGFR为30 - 59ml/（min·1.73m²）。二甲双胍是最常开具的药物（n = 7408；77.0%），52%患者的二甲双胍处方剂量不符合指南。136例中123例（90.5%）开具钠-葡萄糖协同转运蛋白2抑制剂以及2194例中1114例（50.8%）开具二肽基肽酶-4抑制剂的患者，其处方剂量不符合指南。年龄减小、男性或正在使用胰岛素与至少有一张处方不符合指南的几率增加相关。
近一半的T2D合并肾功能损害患者开具了剂量不符合现行澳大利亚指南的非胰岛素类降糖药物，其中大多数患者的eGFR符合3期慢性肾脏病。
