Renal disease is a common complication of type 2 diabetes (T2DM) that affects one in three patients. In fact, the global rise in the incidence of end-stage renal disease, dialysis, and renal transplantations can be attributed primarily to the increasing prevalence of T2DM. The co-occurrence of T2DM and chronic kidney disease (CKD) is associated with greater insulin resistance, progression of T2DM, and an increased risk of developing cardiovascular disease (CVD). Furthermore, the therapeutic management of patients with T2DM is complicated by CKD, as renal impairment also decreases the clearance of most glucose-lowering medications – predisposing patients to drug-related toxicities, particularly low blood sugar. The recent publication of landmark clinical trials has shown that certain glucose lowering agents – such as sodium/glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide 1 receptor agonists (GLP-1RA) reduce the incidence of adverse kidney outcomes. However, it is currently unclear whether these benefits observed in clinical trials have resulted in a quantifiable change in prescribing patterns of glucose-lowering agents, especially in patients with CKD. The overall purpose of this proposal is to examine the trends in the use of glucose-lowering medications in patients with T2DM between 2000-2020 and compare these trends in patients with and without CKD. We will examine the historical use of glucose-lowering therapies and estimate how the publication of these landmark clinical trials have impacted prescribing patterns.
Renal disease is a common complication of type 2 diabetes (T2DM) affecting one in three patients. In fact, the global rise in the incidence of end-stage renal disease, dialysis, and renal transplantations can be attributed primarily to the increasing prevalence of T2DM. The co-occurrence of T2DM and chronic kidney disease augurs a long-term clinical course characterized by greater insulin resistance, accelerated progression of T2DM, and an increased risk of developing cardiovascular disease (CVD). Meanwhile, chronic renal insufficiency also decreases the clearance of most antidiabetic agents and their active metabolites – predisposing patients to drug-related toxicities, particularly hypoglycaemia. The recent publication of landmark clinical trials has shown that certain glucose lowering agents – such as sodium/glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide 1 receptor agonists (GLP-1RA) reduce the incidence of adverse renal events. However, it is currently unclear whether these benefits observed in clinical trials have resulted in a quantifiable change in prescribing patterns of glucose lowering agents, especially in patients with CKD. The overall purpose of this proposal is to examine the trends in the use of glucose-lowering medications in patients with T2DM between 2000-2020 and compare these trends in patients with and without CKD. We will examine the historical use of glucose lowering therapies and estimate how the publication of these landmark clinical trials have impacted prescribing patterns. We will achieve this objective by conducting serial cross-sectional studies (by year) describing the trends in the patterns of initiating of glucose lowering agents. We will also identify patient characteristics (e.g. albuminuria, cardiovascular disease) that facilitate the adoption of these newer glucose lowering therapies.
This is a drug utilization study, and thus there are no outcomes of interest.
Julia Liaw - Chief Investigator - Rutgers, The State University of New Jersey
Julia Liaw - Corresponding Applicant - Rutgers, The State University of New Jersey
Abner Nyandege - Collaborator - Rutgers, The State University of New Jersey
Chintan Dave - Collaborator - Rutgers, The State University of New Jersey