title: Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease.
abstract: Diabetes mellitus, heart failure (HF), and chronic kidney disease are common comorbidities, but overall use and safety of antihyperglycemic medications (AHMs) among patients with these comorbidities are poorly understood.
  
  
  
  Using Get With the Guidelines-Heart Failure and linked Medicare Part D data, we assessed AHM use within 90 days of hospital discharge among HF patients with diabetes mellitus discharged from Get With the Guidelines-Heart Failure hospitals between January 1, 2006, and October 1, 2011. We further summarized use by renal function and assessed renal contraindicated AHM use for patients with estimated glomerular filtration rate <30 mL/min/1.73m(2). Among 8791 patients meeting inclusion criteria, the median age was 77 (interquartile range 71-83), 62.3% were female, median body mass index was 29.7 (interquartile range 25.5-35.3), median hemoglobin A1c was 6.8 (interquartile range 6.2-7.8), and 34% had ejection fraction <40%. 74.9% of patients filled a prescription for an AHM, with insulin (39.5%), sulfonylureas (32.4%), and metformin (17%) being the most commonly used AHMs. Insulin use was higher and sulfonylurea/metformin use was lower among patients with lower renal function classes. Among 1512 patients with estimated glomerular filtration rate <30 mL/min/1.73m(2), 35.4% filled prescriptions for renal contraindicated AHMs per prescribing information, though there was a trend toward lower renal contraindicated AHM use over time (Cochran-Mantel-Haenszel row-mean score test P=0.048). Although use of other AHMs was low overall, thiazolidinediones were used in 6.6% of HF patients, and dipeptidyl peptidase-4 inhibitors were used in 5.1%, with trends for decreasing thiazolidinedione use and increased dipeptidyl peptidase-4 inhibitor use over time (P<0.001).
  
  
  
  Treatment of diabetes mellitus in patients with HF and chronic kidney disease is complex, and these patients are commonly treated with renal contraindicated AHMs, including over 6% receiving a thiazolidinedione, despite known concerns regarding HF. More research regarding safety and efficacy of various AHMs among HF patients is needed.
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.). priyesh.patel@dm.duke.edu.
authors.forename: Priyesh A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Prateeti
authors.initials: P
authors.lastname: Khazanie
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., L.L., P.K., B.G.H., L.H.C., A.F.H.); Ronald Reagan University of California Los Angeles Medical Center (G.C.F.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Duke University Medical Center, Durham, NC (A.F.H.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D000075202:Contraindications; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D018450:Disease Progression; D017723:Drug Utilization Review; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents; D007342:Insurance Benefits; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D054524:Medicare Part D; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents
keywords: chronic kidney disease diabetes mellitus; glomerular filtration rate; heart failure; insulin