Outcomes associated with nonconcordance to National Kidney Foundation guideline recommendations for oral antidiabetic drug treatments in patients with concomitant type 2 diabetes and chronic kidney disease.
OBJECTIVE
To assess the association between oral antidiabetic drug (OAD) treatment concordance with National Kidney Foundation (NKF) guidelines and related economic and clinical outcomes in patients with type 2 diabetes mellitus (T2DM) and stage 3 to 5 chronic kidney disease (CKD).


METHODS
Analysis of nationwide health administrative claims and laboratory findings for the years 2005 to 2010 for a commercially insured U.S. population. T2DM patients age 18 to 64 years were selected if they had stage 3 to 5 CKD as identified using medical claims (International Classification of Diseases-9-CM codes 585.3-585.6), evidence of dialysis procedures, or laboratory findings showing an estimated glomerular filtration rate <60 mL/min/1.73 m2 (date of first CKD as the index date). OADs prescribed during the 6 months following the index date were evaluated to determine guideline concordance. Outcomes examined included glycemic control, healthcare costs and resource utilization, and severe hypoglycemic events. Regression models were used to assess the association between guideline nonconcordance and outcomes.


RESULTS
Of the final study sample (N = 3,300), 58.3% were nonconcordant with guidelines. After adjusting for patient characteristics, the nonconcordant patients were more likely to have severe hypoglycemic events (hazard ratio, 1.24; 95% confidence interval [CI], 1.03-1.49) and less likely to have glycemic control (odds ratio [OR], 0.70; 95% CI, 0.57-0.85) than guideline-concordant patients. Likelihood of hospital admission (OR, 0.95; 95% CI, 0.79-1.15) and annual total healthcare costs (adjusted difference, -$2,227; P = .051) were similar between cohorts.


CONCLUSIONS
In T2DM patients with moderate to severe CKD, OAD treatment not concordant with guidelines is associated with a higher risk of severe hypoglycemic events and uncontrolled glycemic levels.
Health Economics & Epidemiology, Evidera, Lexington, Massachusetts.
Shih-Yin
SY
Chen
Health Economics & Epidemiology, Evidera, Lexington, Massachusetts.
Yuan-Chi
YC
Lee
Health Economics & Epidemiology, Evidera, Lexington, Massachusetts.
Veronica
V
Alas
Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.
Mallik
M
Greene
Department of Pharmacotherapy, University Utah College of Pharmacy, Salt Lake City, Utah.
Diana
D
Brixner
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*
D001786:Blood Glucose; D007004:Hypoglycemic Agents