Zhao Julie Z, Weinhandl Eric D, Carlson Angeline M, St Peter Wendy L
Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN.
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN.
Kidney Med. 2022 Jun 26;4(8):100510. doi: 10.1016/j.xkme.2022.100510. eCollection 2022 Aug.
RATIONALE & OBJECTIVE: Information on safety issues of newer glucose-lowering medications from a large population perspective in chronic kidney disease (CKD) patients with type 2 diabetes is limited. Our study aimed to examine hypoglycemia risk associated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) versus second-generation sulfonylureas in a general population of older patients with CKD and type 2 diabetes, across race, age, sex, and socioeconomic subgroups.
Retrospective cohort.
SETTING & PARTICIPANTS: The 20% random sample of Medicare fee-for-service claims, 2012-2018.
Use of SGLT2is, GLP-1RAs, or sulfonylureas.
Hypoglycemic events resulting in health care utilization.
Cox proportional hazard model evaluated the 90-day risk of hypoglycemia associated with SGLT2is or GLP-1RAs versus sulfonylureas.
A total of 18,567 adults (mean age: 73 years) with CKD and type 2 diabetes was included; 14.0% ( = 2,528) had a prescription for a SGLT2i or GLP-1RA, and 86.0% ( = 16,039) with a sulfonylurea. Compared with sulfonylureas, use of SGLT2is or GLP-1RAs was associated with a significantly lower risk of hypoglycemia (adjusted HR, 0.30; 95% CI, 0.14-0.65). Black individuals had higher risk of developing hypoglycemia than White individuals (adjusted HR, 1.55; 95% CI, 1.07-2.26). Low-income subsidy compared to no low-income subsidy status was associated with higher risk of hypoglycemic events. The risk of hypoglycemia also increased with higher comorbid condition score.
CKD and type 2 diabetes diagnosis, CKD stage, and patient clinical status were identified with diagnosis or procedure codes. There is potential for residual confounding with use of retrospective data.
Use of SGLT2is or GLP-1RAs compared with sulfonylureas was associated with a lower risk of hypoglycemia among patients with CKD and type 2 diabetes. Black race was not only associated with lower use of newer agents with demonstrated cardiovascular and kidney benefits and lower hypoglycemia risk, but also with a higher rate of hypoglycemic events as compared with White individuals.
从大量人群的角度来看，关于慢性肾脏病（CKD）合并2型糖尿病患者中新型降糖药物安全性问题的信息有限。我们的研究旨在探讨在患有CKD和2型糖尿病的老年患者总体人群中，跨种族、年龄、性别和社会经济亚组，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）和胰高血糖素样肽1受体激动剂（GLP-1RAs）与第二代磺脲类药物相比的低血糖风险。
回顾性队列研究。
2012 - 2018年医疗保险按服务收费索赔的20%随机样本。
使用SGLT2is、GLP-1RAs或磺脲类药物。
导致医疗保健利用的低血糖事件。
Cox比例风险模型评估了SGLT2is或GLP-1RAs与磺脲类药物相比的90天低血糖风险。
共纳入18567名患有CKD和2型糖尿病的成年人（平均年龄：73岁）；14.0%（n = 2528）有SGLT2i或GLP-1RA的处方，86.0%（n = 16039）有磺脲类药物的处方。与磺脲类药物相比，使用SGLT2is或GLP-1RAs与低血糖风险显著降低相关（调整后HR，0.30；95%CI，0.14 - 0.65）。黑人发生低血糖的风险高于白人（调整后HR，1.55；95%CI，1.07 - 2.26）。与无低收入补贴状态相比，低收入补贴与低血糖事件风险较高相关。低血糖风险也随着合并症评分升高而增加。
CKD和2型糖尿病的诊断、CKD分期以及患者临床状态通过诊断或程序代码确定。使用回顾性数据存在残余混杂的可能性。
与磺脲类药物相比，在患有CKD和2型糖尿病的患者中，使用SGLT2is或GLP-1RAs与低血糖风险较低相关。黑人种族不仅与具有心血管和肾脏益处且低血糖风险较低的新型药物使用率较低有关，而且与白人相比低血糖事件发生率较高有关。
