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Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort
BACKGROUND: Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902996/ https://www.ncbi.nlm.nih.gov/pubmed/27286816 http://dx.doi.org/10.1186/s12882-016-0273-z |
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author | Busch, Martin Nadal, Jennifer Schmid, Matthias Paul, Katharina Titze, Stephanie Hübner, Silvia Köttgen, Anna Schultheiss, Ulla T. Baid-Agrawal, Seema Lorenzen, Johan Schlieper, Georg Sommerer, Claudia Krane, Vera Hilge, Robert Kielstein, Jan T. Kronenberg, Florian Wanner, Christoph Eckardt, Kai-Uwe Wolf, Gunter |
author_facet | Busch, Martin Nadal, Jennifer Schmid, Matthias Paul, Katharina Titze, Stephanie Hübner, Silvia Köttgen, Anna Schultheiss, Ulla T. Baid-Agrawal, Seema Lorenzen, Johan Schlieper, Georg Sommerer, Claudia Krane, Vera Hilge, Robert Kielstein, Jan T. Kronenberg, Florian Wanner, Christoph Eckardt, Kai-Uwe Wolf, Gunter |
author_sort | Busch, Martin |
collection | PubMed |
description | BACKGROUND: Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD. METHODS: The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18–74 years with an estimated glomerular filtration rate (eGFR) between 30–60 mL/min/1.73 m(2) or proteinuria >0.5 g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure. RESULTS: At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25(th)–75(th) percentile: 6.8–7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral antidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was used by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase of 1 kg/m(2), 95 % CI 1.02–1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04–1.18), treatment with insulin alone (OR = 5.63, 95 % CI 4.26–7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77–6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides. CONCLUSIONS: Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0273-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4902996 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-49029962016-06-12 Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort Busch, Martin Nadal, Jennifer Schmid, Matthias Paul, Katharina Titze, Stephanie Hübner, Silvia Köttgen, Anna Schultheiss, Ulla T. Baid-Agrawal, Seema Lorenzen, Johan Schlieper, Georg Sommerer, Claudia Krane, Vera Hilge, Robert Kielstein, Jan T. Kronenberg, Florian Wanner, Christoph Eckardt, Kai-Uwe Wolf, Gunter BMC Nephrol Research Article BACKGROUND: Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD. METHODS: The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18–74 years with an estimated glomerular filtration rate (eGFR) between 30–60 mL/min/1.73 m(2) or proteinuria >0.5 g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure. RESULTS: At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25(th)–75(th) percentile: 6.8–7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral antidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was used by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase of 1 kg/m(2), 95 % CI 1.02–1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04–1.18), treatment with insulin alone (OR = 5.63, 95 % CI 4.26–7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77–6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides. CONCLUSIONS: Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0273-z) contains supplementary material, which is available to authorized users. BioMed Central 2016-06-11 /pmc/articles/PMC4902996/ /pubmed/27286816 http://dx.doi.org/10.1186/s12882-016-0273-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Busch, Martin Nadal, Jennifer Schmid, Matthias Paul, Katharina Titze, Stephanie Hübner, Silvia Köttgen, Anna Schultheiss, Ulla T. Baid-Agrawal, Seema Lorenzen, Johan Schlieper, Georg Sommerer, Claudia Krane, Vera Hilge, Robert Kielstein, Jan T. Kronenberg, Florian Wanner, Christoph Eckardt, Kai-Uwe Wolf, Gunter Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort |
title | Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort |
title_full | Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort |
title_fullStr | Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort |
title_full_unstemmed | Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort |
title_short | Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort |
title_sort | glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the german chronic kidney disease (gckd) cohort |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902996/ https://www.ncbi.nlm.nih.gov/pubmed/27286816 http://dx.doi.org/10.1186/s12882-016-0273-z |
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