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.
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.



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.



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.



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.
Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, D - 07747, Jena, Germany. martin.busch@med.uni-jena.de.
Martin
M
Busch
Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
Jennifer
J
Nadal
Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
Matthias
M
Schmid
Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, D - 07747, Jena, Germany.
Katharina
K
Paul
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Stephanie
S
Titze
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Silvia
S
Hübner
Department of Internal Medicine IV, Medical Center University of Freiburg, Freiburg, Germany.
Anna
A
Köttgen
Department of Internal Medicine IV, Medical Center University of Freiburg, Freiburg, Germany.
Ulla T
UT
Schultheiss
Department of Medicine, Division of Nephrology and Medical Intensive Care, University Hospital Charité, Berlin, Germany.
Seema
S
Baid-Agrawal
Hannover Medical School, Clinic for Nephrology, Hannover, Germany.
Johan
J
Lorenzen
Department of Medicine II - Nephrology and Clinical Immunology, University Hospital Aachen, Aachen, Germany.
Georg
G
Schlieper
Department of Medicine, Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany.
Claudia
C
Sommerer
Department of Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
Vera
V
Krane
Department of Medicine IV, Division of Nephrology, University Hospital of Ludwig-Maximilians University Munich, Munich, Germany.
Robert
R
Hilge
Hannover Medical School, Clinic for Nephrology, Hannover, Germany.
Jan T
JT
Kielstein
Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
Florian
F
Kronenberg
Department of Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
Christoph
C
Wanner
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Kai-Uwe
KU
Eckardt
Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, D - 07747, Jena, Germany.
Gunter
G
Wolf
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D013223:Statistics as Topic
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
Chronic kidney disease; Diabetes mellitus; Glycaemic control; Hemoglobin A1C; Insulin therapy; Oral antidiabetic drugs