Clinical Practice Considerations and Review of the Literature for the Use of DPP-4 Inhibitors in Patients with Type 2 Diabetes and Chronic Kidney Disease

Abstract Background Recent European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) guidelines provide recommendations for detecting and treating chronic kidney disease (CKD) in diabetic patients. We compared clinical practice with guidelines to determine areas for improvement. Methods German database analysis of 675,628 patients with type 1 or type 2 diabetes, with 134,395 included in this analysis. Data were compared with ESC/EASD recommendations. Results This analysis included 17,649 and 116,747 patients with type 1 and type 2 diabetes, respectively. The analysis showed that 44.1 and 49.1 % patients with type 1 and type 2 diabetes, respectively, were annually screened for CKD. Despite anti-diabetic treatment, only 27.2 % patients with type 1 and 43.5 % patients with type 2 achieved a target HbA1c of < 7.0 %. Use of sodium-glucose transport protein 2 inhibitors (1.5 % type 1/8.7 % type 2 diabetes) and glucagon-like peptide-1 receptor agonists (0.6 % type 1/5.2 % type 2 diabetes) was limited. Hypertension was controlled according to guidelines in 41.1 and 67.7 % patients aged 18–65 years with type 1 and 2 diabetes, respectively, (62.4 vs. 68.4 % in patients > 65 years). Renin angiotensin aldosterone inhibitors were used in 24.0 and 40.9 % patients with type 1 diabetes (micro- vs. macroalbuminuria) and 39.9 and 47.7 %, respectively, in type 2 diabetes. Conclusions Data indicate there is room for improvement in caring for diabetic patients with respect to renal disease diagnosis and treatment. While specific and potentially clinically justified reasons for non-compliance exist, the data may serve well for a critical appraisal of clinical practice decisions.

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Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120935701 ◽

2020 ◽

Vol 7 ◽

pp. 205435812093570

Author(s):

Lisa Dubrofsky ◽

Anand Srivastava ◽

David Z. Cherney

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Primary Care Physicians ◽

Real Life ◽

Atherosclerotic Cardiovascular Disease ◽

Specific Patient ◽

Sodium Glucose Cotransporter

Purpose of the review: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended for eligible patients with type 2 diabetes for the secondary prevention of adverse cardiovascular and kidney disease outcomes. Patients with type 2 diabetes and albuminuric chronic kidney disease, a history of atherosclerotic cardiovascular disease, and/or heart failure with reduced ejection fraction should be assessed for the use of these therapies. Sources of information: The sources include published clinical trials with SGLT2is, with a focus on cardiovascular safety studies and kidney protection trials. Methods: Information was gathered via a review of relevant literature and clinical practice guidelines, incorporated with real-life clinical experience. Key findings: Clinicians prescribing these agents must be familiar with the benefits of SGLT2is on cardiovascular and renal endpoints, and with adverse effects of SGLT2is, including mycotic genital infections and diabetic ketoacidosis. Primary care physicians and specialists should know how to adjust antihypertensive, antiglycemic, and diuretic agents. With the results of completed cardiovascular outcome trials and the Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy trial, nephrologists specifically have a unique opportunity to impact the safe, effective, and equitable implementation of SGLT2is into clinical practice. Limitations: Further work is needed in specific patient subgroups, including patients with chronic kidney disease stages IV and V, patients with kidney disease but lower levels of albuminuria, and in patients without diabetes.

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Finerenone: A Novel Mineralocorticoid Receptor Antagonist for Cardiorenal Protection in CKD and T2DM

Annals of Pharmacotherapy ◽

10.1177/10600280211059577 ◽

2022 ◽

pp. 106002802110595

Author(s):

Allissa Long ◽

Marissa Salvo

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Clinical Practice ◽

Kidney Disease ◽

Safety Information ◽

Mineralocorticoid Receptor Antagonist ◽

Sodium Glucose Cotransporter

Objective: To describe the pharmacology, clinical and safety evidence, and relevance to clinical practice of finerenone. Data Sources: A literature search was conducted utilizing PubMed, MEDLINE, and clinicaltrials.gov with search terms of “finerenone” and “BAY94-8862.” Study Selection and Data Extraction All available studies with human participants in English were considered. Studies were included if they investigated drug pharmacology, efficacy, and safety information. Data Synthesis In addition to standard of care with a renin-angiotensin system inhibitor (RASi), finerenone lowered the risk of kidney disease progression (17.8% vs 21.1%) in patients with type 2 diabetes mellitus and chronic kidney disease compared to placebo. Similarly, finerenone reduced cardiovascular risk in patients with type 2 diabetes mellitus and chronic kidney disease compared to placebo (12.4% vs 14.2%). Relevance to Patient Care and Clinical Practice It is anticipated that finerenone will be added to therapy after a RASi and a sodium-glucose cotransporter-2 inhibitor, as tolerated, based on adverse events and potassium levels. Conclusions Finerenone offers a unique approach to further delay the progression of chronic kidney disease in patients with type 2 diabetes mellitus. It also provides another option for patients who cannot tolerate RASi or sodium-glucose cotransporter-2 inhibitors.

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Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

10.2337/figshare.14669748.v1 ◽

2021 ◽

Author(s):

Nikita Stempniewicz ◽

Joseph A. Vassalotti ◽

John K. Cuddeback ◽

Elizabeth Ciemins ◽

Amy Storfer-Isser ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Health Care ◽

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Health Care Organizations ◽

The United States ◽

Testing Rate

Objective: Clinical guidelines for people with diabetes recommend chronic kidney disease (CKD) testing at least annually using estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the United States. Research Design and Methods: Electronic health record data were analyzed from 513,165 adults with type 2 diabetes, receiving primary care from 24 health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both ≥1 eGFR and ≥1 uACR, <a></a><a>and each test</a> individually, in the 1, 2, and 3 years ending September 2019, by health care organization and clinical practice site. Elevated albuminuria was defined by uACR ≥30 mg/g. Results: The 1-year median testing rate across organizations was 51.6% for both uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10th–90th percentile) from 44.7% to 63.3% across organizations and from 13.3% to 75.4% across sites. Over 3 years, the median testing rate for uACR across organizations was 73.7%. Overall, the prevalence of detected elevated albuminuria was 15%. The average prevalence of detected elevated albuminuria increased linearly with uACR testing rates at sites, with estimated prevalence of 6%, 15%, and 30%, at uACR testing rates of 20%, 50%, and 100%. Conclusions: While eGFR testing rates are uniformly high among people with type 2 diabetes, testing rates for uACR are suboptimal and highly variable across and within the organizations examined. Guideline-recommended uACR testing should increase detection of CKD.

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Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

10.2337/figshare.14669748 ◽

2021 ◽

Author(s):

Nikita Stempniewicz ◽

Joseph A. Vassalotti ◽

John K. Cuddeback ◽

Elizabeth Ciemins ◽

Amy Storfer-Isser ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Health Care ◽

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Health Care Organizations ◽

The United States ◽

Testing Rate

Objective: Clinical guidelines for people with diabetes recommend chronic kidney disease (CKD) testing at least annually using estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the United States. Research Design and Methods: Electronic health record data were analyzed from 513,165 adults with type 2 diabetes, receiving primary care from 24 health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both ≥1 eGFR and ≥1 uACR, <a></a><a>and each test</a> individually, in the 1, 2, and 3 years ending September 2019, by health care organization and clinical practice site. Elevated albuminuria was defined by uACR ≥30 mg/g. Results: The 1-year median testing rate across organizations was 51.6% for both uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10th–90th percentile) from 44.7% to 63.3% across organizations and from 13.3% to 75.4% across sites. Over 3 years, the median testing rate for uACR across organizations was 73.7%. Overall, the prevalence of detected elevated albuminuria was 15%. The average prevalence of detected elevated albuminuria increased linearly with uACR testing rates at sites, with estimated prevalence of 6%, 15%, and 30%, at uACR testing rates of 20%, 50%, and 100%. Conclusions: While eGFR testing rates are uniformly high among people with type 2 diabetes, testing rates for uACR are suboptimal and highly variable across and within the organizations examined. Guideline-recommended uACR testing should increase detection of CKD.

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Abstract #802036: Safety and Efficacy of Faster Acting Insulin Aspart in People With Type 2 Diabetes and Chronic Kidney Disease: A Real-World Study from India

Endocrine Practice ◽

10.1016/s1530-891x(20)39507-0 ◽

2020 ◽

Vol 26 ◽

pp. 101-102

Author(s):

Supratik Bhattacharyya

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Real World ◽

Insulin Aspart ◽

Safety And Efficacy ◽

Acting Insulin

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No effect of vitamin D supplementation on metabolic parameters but on lipids in patients with type 2 diabetes and chronic kidney disease

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000642 ◽

2020 ◽

pp. 1-10

Author(s):

Jiwoon Kim ◽

Ji Sun Nam ◽

Heejung Kim ◽

Hye Sun Lee ◽

Jung Eun Lee

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Vitamin D Supplementation ◽

Lipid Profiles ◽

Metabolic Parameters ◽

Injection Group ◽

Different Doses

Abstract. Background/Aims: Trials on the effects of cholecalciferol supplementation in type 2 diabetes with chronic kidney disease patients were underexplored. Therefore, the aim of this study was to investigate the effects of two different doses of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentrations and metabolic parameters in vitamin D-deficient Korean diabetes patients with chronic kidney disease. Methods: 92 patients completed this study: the placebo group (A, n = 33), the oral cholecalciferol 1,000 IU/day group (B, n = 34), or the single 200,000 IU injection group (C, n = 25, equivalent to 2,000 IU/day). 52% of the patients had less than 60 mL/min/1.73m2 of glomerular filtration rates. Laboratory test and pulse wave velocity were performed before and after supplementation. Results: After 12 weeks, serum 25(OH)D concentrations of the patients who received vitamin D supplementation were significantly increased (A, -2.4 ± 1.2 ng/mL vs. B, 10.7 ± 1.2 ng/mL vs. C, 14.6 ± 1.7 ng/mL; p < 0.001). In addition, the lipid profiles in the vitamin D injection group (C) showed a significant decrease in triglyceride and a rise in HDL cholesterol. However, the other parameters showed no differences. Conclusions: Our data indicated that two different doses and routes of vitamin D administration significantly and safely increased serum 25(OH)D concentrations in vitamin D-deficient diabetes patients with comorbid chronic kidney disease. In the group that received the higher vitamin D dose, the lipid profiles showed significant improvement, but there were no beneficial effects on other metabolic parameters.

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