Royal North Shore Hospital, Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia.
Global Market Access and Pricing, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
Diabet Med. 2024 Feb;41(2):e15200. doi: 10.1111/dme.15200. Epub 2023 Aug 26.
To describe treatment pathways for key glucose-lowering therapies in individuals with chronic kidney disease (CKD) and type 2 diabetes (T2D) using retrospective data from DISCOVER CKD (NCT04034992).
Data were extracted from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics data (2008-2020) and the US integrated Limited Claims and Electronic Health Records Database (LCED; 2012-2019). Eligible individuals were aged ≥18 years with CKD, identified by two consecutive estimated glomerular filtration rate (eGFR) measures (15-<75 mL/min/1.73 m ; 90-730 days apart; index date was the second measurement) and T2D. Chronological treatment pathways for glucose-lowering therapies prescribed on or after CKD index to end of follow-up were computed. Median time and proportion of overall follow-up time on treatment were described for each therapy by database and by eGFR and urinary albumin-to-creatinine ratio (UACR) categories.
Of 36,951 and 4339 eligible individuals in the CPRD and LCED, respectively, median baseline eGFR was 67.8 and 64.9 mL/min/1.73 m ; 64.2 and 63.9% received metformin prior to index; and median (interquartile range) time on metformin during follow-up was 917 (390-1671) and 454 (192-850) days (accounting for ~75% of follow-up time in both databases). The frequency of combination treatment increased over time. There were trends towards decreased metformin prescriptions with decreasing eGFR and increasing UACR within each eGFR category.
Individuals with CKD and T2D had many combinations of therapies and substantial follow-up time on therapy. These results highlight opportunities for improved CKD management.
利用 DISCOVER CKD（NCT04034992）的回顾性数据，描述慢性肾脏病（CKD）和 2 型糖尿病（T2D）患者关键降糖治疗的治疗途径。
从英国临床实践研究数据链（CPRD）中提取数据，并与医院发病统计数据（2008-2020 年）相关联，同时从美国综合有限索赔和电子健康记录数据库（LCED；2012-2019 年）中提取数据。符合条件的个体年龄≥18 岁，患有 CKD，通过两次连续估计肾小球滤过率（eGFR）测量（15-<75 mL/min/1.73 m ；90-730 天分开；索引日期为第二次测量）和 T2D 确定。计算 CKD 指数后至随访结束时开具的降糖治疗的降血糖治疗的时间顺序治疗途径。描述了每个数据库和 eGFR 和尿白蛋白/肌酐比（UACR）分类的治疗中位时间和总随访时间比例。
在 CPRD 和 LCED 中，分别有 36951 名和 4339 名符合条件的个体，中位基线 eGFR 分别为 67.8 和 64.9 mL/min/1.73 m ；64.2%和 63.9%在索引前接受二甲双胍治疗；在随访期间，接受二甲双胍治疗的中位（四分位间距）时间分别为 917（390-1671）和 454（192-850）天（占两个数据库中随访时间的~75%）。随着时间的推移，联合治疗的频率增加。在每个 eGFR 类别中，随着 eGFR 的降低和 UACR 的增加，二甲双胍的处方频率呈下降趋势。
患有 CKD 和 T2D 的个体有多种治疗方法组合，并且接受了大量的治疗时间。这些结果突出了改善 CKD 管理的机会。
