Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ.
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ.
Diabetes Care. 2022 Oct 1;45(10):2316-2325. doi: 10.2337/dc22-0224.
To evaluate trends in antidiabetic medication initiation patterns among patients with type 2 diabetes mellitus (T2DM) with and without chronic kidney disease (CKD).
A retrospective cohort study using the UK Clinical Practice Research Datalink (2006-2020) was conducted to evaluate the overall, first-, and second line (after metformin) medication initiation patterns among patients with CKD (n = 38,622) and those without CKD (n = 230,963) who had T2DM.
Relative to other glucose-lowering therapies, metformin initiations declined overall but remained the first-line treatment of choice for both patients with and those without CKD. Sodium-glucose cotransporter-2 (SGLT2i) use increased modestly among patients with CKD, but this increase was more pronounced among patients without CKD; by 2020, patients without CKD, compared with patients with CKD, were three (28.5% vs. 9.4%) and six (46.3% vs. 7.9%) times more likely to initiate SGLT2i overall and as second-line therapy, respectively. Glucagon-like peptide 1 receptor agonist (GLP-1RA) use was minimal regardless of CKD status (<5%), whereas both dipeptidyl peptidase-4 inhibitor (DPP4i) and sulfonylurea use remained high among patients with CKD. For instance, by 2020, and among patients with CKD, DPP4i and sulfonylureas constituted 28.3% and 20.6% of all initiations, and 57.4% and 30.3% of second-line initiations, respectively.
SGLT2i use increased among patients with T2DM, but this increase was largely driven by patients without CKD. Work is needed to identify barriers associated with the uptake of therapies with proven cardiorenal benefits (e.g., SGLT2i, GLP-1RA) among patients with CKD.
评估伴有和不伴有慢性肾脏病（CKD）的 2 型糖尿病（T2DM）患者起始抗糖尿病药物治疗模式的趋势。
利用英国临床实践研究数据链接（2006-2020 年）进行了一项回顾性队列研究，以评估伴有 CKD（n=38622）和不伴有 CKD（n=230963）的 T2DM 患者的总体、一线（二甲双胍后）和二线（SGLT2i 后）药物起始模式。
与其他降糖治疗相比，二甲双胍的起始率总体下降，但仍是伴有和不伴有 CKD 的患者的首选一线治疗。SGLT2i 的使用在伴有 CKD 的患者中略有增加，但在不伴有 CKD 的患者中更为明显；到 2020 年，与伴有 CKD 的患者相比，不伴有 CKD 的患者总体上起始 SGLT2i 的可能性分别高出 3 倍（28.5%比 9.4%）和 6 倍（46.3%比 7.9%），且起始 SGLT2i 作为二线治疗的可能性也分别高出 3 倍和 6 倍。无论 CKD 状态如何，GLP-1RA 的使用都很少（<5%），而 DPP4i 和磺脲类药物的使用在伴有 CKD 的患者中仍然很高。例如，到 2020 年，在伴有 CKD 的患者中，DPP4i 和磺脲类药物分别占所有起始治疗的 28.3%和 20.6%，占二线起始治疗的 57.4%和 30.3%。
SGLT2i 的使用在 T2DM 患者中有所增加，但这主要是由不伴有 CKD 的患者驱动的。需要努力确定与 CKD 患者采用具有明确心脏肾脏获益的治疗方法（如 SGLT2i、GLP-1RA）相关的障碍。
