title: Age, renal dysfunction, cardiovascular disease, and antihyperglycemic treatment in type 2 diabetes mellitus: findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study.
abstract: OBJECTIVE
  To assess the distribution of antihyperglycemic treatments according to age and renal function and its relationship with cardiovascular disease in type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Nineteen hospital-based diabetes mellitus clinics in 2007 and 2008.
  
  
  METHODS
  Fifteen thousand seven hundred thirty-three individuals with T2DM from the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study.
  
  
  METHODS
  Current antihyperglycemic treatments were recorded. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Albuminuria was measured using immunonephelometry or immunoturbidimetry. Prevalence of major acute cardiovascular events was calculated according to age quartiles, treatments, and categories of eGFR (1 = ≥90; 2 = 60-89; 3 = 30-59; and 4 = <30 mL/min per 1.73 m(2) ).
  
  
  RESULTS
  Across age quartiles, eGFR declined progressively at a time-linear rate, with an acceleration in older adults, whereas albuminuria increased; age and eGFR were associated with cardiovascular events independently of other confounders. With increasing age, percentage of participants using lifestyle treatments for their T2DM and taking metformin or glitazones fell; percentage taking sulphonylureas and repaglinide rose, and percentage taking insulin remained stable. In eGFR categories 3 and 4, use of metformin was 41.4% and 14.5%, respectively, and that of sulphonylureas was 34.2% and 18.1%, respectively. Inappropriate prescription of these agents, especially sulphonylureas, increased with age. Metformin was independently associated with lower prevalence of cardiovascular disease for any age quartile and eGFR category than all other treatments.
  
  
  CONCLUSIONS
  In real-life conditions, use of agents that are not recommended in elderly adults with diabetes mellitus with moderate to severe renal impairment is frequent, but metformin is associated with lower cardiovascular event rates even in these individuals.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. anna.solini@med.unipi.it
authors.forename: Anna
authors.initials: A
authors.lastname: Solini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Penno
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fondelli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orsi
authors.forename: Roberto
authors.initials: R
authors.lastname: Trevisan
authors.forename: Monica
authors.initials: M
authors.lastname: Vedovato
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalot
authors.forename: Mauro
authors.initials: M
authors.lastname: Cignarelli
authors.forename: Susanna
authors.initials: S
authors.lastname: Morano
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D015438:Health Behavior; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007558:Italy; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D008019:Life Style; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D008687:Metformin
keywords: age; albuminuria; cardiovascular disease; glomerular filtration rate; oral hypoglycemic agents