Antihyperglycemic treatment in patients with type 2 diabetes in Italy: the impact of age and kidney function
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Sandro Gentile1, Pamela Piscitelli2, Francesca Viazzi3, Giuseppina Russo4, Antonio Ceriello5,6, Carlo Giorda7, Piero Guida8, Paola Fioretto9, Roberto Pontremoli3, Felice Strollo10, Salvatore De Cosmo2 and The AMD-Annals Study Group11
1Department of Clinical and Experimental Medicine, University of Campania, Naples, Italy
2IRCSS Casa Sollievo della Sofferenza – Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, Italy
3Università degli Studi, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
4Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
5Insititut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
6U.O. Diabetologia e Malattie Metaboliche, Multimedica IRCCS, Milano, Italy
7Diabetes and Metabolism Unit, ASL Turin 5, Turin, Italy
8Statistical Consultant for Associazione Medici Diabetologi (AMD), Rome, Italy
9Department of Medicine, University of Padova, Padova, Italy
10Endocrinology and Metabolism, Elle-di, Rome, Italy
11Associazione Medici Diabetologi (AMD), Rome, Italy
Salvatore De Cosmo, email: firstname.lastname@example.org
Sandro Gentile, email: email@example.com
Keywords: type 2 diabetes mellitus, nephropathy, age, antihyperglycemic treatment, eGFR
Received: May 03, 2017 Accepted: May 10, 2017 Published: June 28, 2017
We describe AHA utilization pattern according to age and renal function in type 2 diabetes mellitus (T2DM), in real-life conditions.
The analysis was performed using the data set of electronic medical records collected between 1 January and 31 December, 2011 in 207 Italian diabetes centers. The study population consisted of 157,595 individuals with T2DM. The AHA treatment regimens was evaluated. Kidney function was assessed by eGFR, estimated using the CKD-EPI formula. Other determinations: HbA1c, blood pressure (BP), low- density lipoprotein (LDL-c), total and high density lipoprotein cholesterol (TC and HDL-c), triglycerides (TG) and serum uric acid (SUA). Quality of care was assessed through Q score.
The proportion of subjects taking metformin declined progressively across age quartiles along with eGFR values, but remained high in oldest subjects (i.e. 54.5 %). On the other hand, the proportion of patients on secretagogues or insulin increased with aging (i.e. 54.7% and 37% in the fourth age quartile, respectively). The percentage of patients with low eGFR (i.e. <30 ml/min/1.73m2) taking either metformin or sulphonilureas/repaglinide was particularly high (i.e. 15.3% and 34.3% respectively).
In a large real-life cohort of T2DM, metformin or sulphonylureas/repaglinide, although not recommended, are frequently prescribed to elderly subjects with severe kidney disease.
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