The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy
Background and Objectives Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antid...
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| Veröffentlicht in: | Clinical drug investigation 2016-03, Vol.36 (3), p.203-212 |
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| creator | Trifirò, Gianluca Parrino, Fabrizio Pizzimenti, Valeria Giorgianni, Francesco Sultana, Janet Muscianisi, Marco Troncone, Chiara Tari, Daniele U. Arcoraci, Vincenzo Santoro, Domenico Russo, Giusi Lacava, Viviana Caputi, Achille P. |
| description | Background and Objectives
Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antidiabetic drug use in DKD patients from Southern Italy.
Methods
The Arianna database from Caserta Local Health Unit was used. Diabetic patients with incident CKD [first diagnosis date: index date (ID)] were identified by searching for specific ICD9-CM codes among hospital discharge diagnoses/procedures and/or indication of use associated with drug prescriptions. To evaluate any change in the use of antidiabetic drugs after the CKD diagnosis, the prevalence of antidiabetic drug use among DKD patients was calculated within 1 year prior to/after ID and after dialysis entry. A Kaplan–Meier analysis was used to assess the time to discontinuation of antidiabetic drugs after CKD diagnosis. The frequency of antidiabetic drugs contraindicated in renal disease in DKD patients was measured.
Results
Overall, 725 diabetic patients (mean age 72.8 ± 11.4 years) had incident CKD from 2006 to 2011. The use of combination antidiabetic drugs, biguanides and sulphonamides decreased by approximately 10, 7 and 5 %, respectively, after the ID. The use of insulins increased by 10 % after the ID and by 20 % after entry into dialysis. The use of antidiabetic drugs not contraindicated in CKD decreased marginally after the diagnosis of CKD.
Conclusion
In a general practice of Southern Italy the management of diabetes mellitus changed only marginally in newly diagnosed CKD patients, suggesting a therapeutic inertia on the part of prescribers. |
| doi_str_mv | 10.1007/s40261-015-0367-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1767067367</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4017728921</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-f87e0ac3a2d99a05523ea1c179fbcb953997dc85caae9998fb3d5c9f2e65ef333</originalsourceid><addsrcrecordid>eNp1kU1PXCEUhomxqVb7A7ppSNx0Q8uHwMWdnX6ZajTRrgmXe66DuQNT4MbMvy_TsU1j0hWE87zvOYcXoTeMvmeU6g_llHLFCGWSUKE0UXvokDFtCDOs2_99F4RLJQ7Qq1IeKGWKKf4SHXClDKe0O0SPd0vAVy66e1hBrDiN-FNwPVQo-AqmKdS54BDxjauh1Qt-DHWJF8ucYvD4exgibJqigCtwhs_xTVrPU2NTJB_b04Bv6zxstg63aa5LyBFfVDdtjtGL0U0FXj-dR-jHl893i2_k8vrrxeL8kniheSVjp4E6LxwfjHFUSi7AMd92HHvfGymM0YPvpHcOjDHd2ItBejNyUBJGIcQRerfzXef0c4ZS7SoU3xZzEdJcLNNKU6Xb7zX05Bn6kOYc23SN0sZIw_mWYjvK51RKhtGuc1i5vLGM2m0qdpeKbanYbSpWNc3bJ-e5X8HwV_EnhgbwHVBaKd5D_qf1f11_AcA1l9A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1779959227</pqid></control><display><type>article</type><title>The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Trifirò, Gianluca ; Parrino, Fabrizio ; Pizzimenti, Valeria ; Giorgianni, Francesco ; Sultana, Janet ; Muscianisi, Marco ; Troncone, Chiara ; Tari, Daniele U. ; Arcoraci, Vincenzo ; Santoro, Domenico ; Russo, Giusi ; Lacava, Viviana ; Caputi, Achille P.</creator><creatorcontrib>Trifirò, Gianluca ; Parrino, Fabrizio ; Pizzimenti, Valeria ; Giorgianni, Francesco ; Sultana, Janet ; Muscianisi, Marco ; Troncone, Chiara ; Tari, Daniele U. ; Arcoraci, Vincenzo ; Santoro, Domenico ; Russo, Giusi ; Lacava, Viviana ; Caputi, Achille P.</creatorcontrib><description>Background and Objectives
Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antidiabetic drug use in DKD patients from Southern Italy.
Methods
The Arianna database from Caserta Local Health Unit was used. Diabetic patients with incident CKD [first diagnosis date: index date (ID)] were identified by searching for specific ICD9-CM codes among hospital discharge diagnoses/procedures and/or indication of use associated with drug prescriptions. To evaluate any change in the use of antidiabetic drugs after the CKD diagnosis, the prevalence of antidiabetic drug use among DKD patients was calculated within 1 year prior to/after ID and after dialysis entry. A Kaplan–Meier analysis was used to assess the time to discontinuation of antidiabetic drugs after CKD diagnosis. The frequency of antidiabetic drugs contraindicated in renal disease in DKD patients was measured.
Results
Overall, 725 diabetic patients (mean age 72.8 ± 11.4 years) had incident CKD from 2006 to 2011. The use of combination antidiabetic drugs, biguanides and sulphonamides decreased by approximately 10, 7 and 5 %, respectively, after the ID. The use of insulins increased by 10 % after the ID and by 20 % after entry into dialysis. The use of antidiabetic drugs not contraindicated in CKD decreased marginally after the diagnosis of CKD.
Conclusion
In a general practice of Southern Italy the management of diabetes mellitus changed only marginally in newly diagnosed CKD patients, suggesting a therapeutic inertia on the part of prescribers.</description><identifier>ISSN: 1173-2563</identifier><identifier>EISSN: 1179-1918</identifier><identifier>DOI: 10.1007/s40261-015-0367-6</identifier><identifier>PMID: 26692008</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Diabetic Nephropathies - physiopathology ; Female ; Humans ; Hypoglycemic Agents - therapeutic use ; Insulin - therapeutic use ; Internal Medicine ; Italy - epidemiology ; Kaplan-Meier Estimate ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Research Article ; Pharmacology/Toxicology ; Pharmacotherapy ; Prevalence ; Renal Insufficiency, Chronic - physiopathology ; Retrospective Studies</subject><ispartof>Clinical drug investigation, 2016-03, Vol.36 (3), p.203-212</ispartof><rights>Springer International Publishing Switzerland 2015</rights><rights>Copyright Springer Science & Business Media Mar 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-f87e0ac3a2d99a05523ea1c179fbcb953997dc85caae9998fb3d5c9f2e65ef333</citedby><cites>FETCH-LOGICAL-c372t-f87e0ac3a2d99a05523ea1c179fbcb953997dc85caae9998fb3d5c9f2e65ef333</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40261-015-0367-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40261-015-0367-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26692008$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trifirò, Gianluca</creatorcontrib><creatorcontrib>Parrino, Fabrizio</creatorcontrib><creatorcontrib>Pizzimenti, Valeria</creatorcontrib><creatorcontrib>Giorgianni, Francesco</creatorcontrib><creatorcontrib>Sultana, Janet</creatorcontrib><creatorcontrib>Muscianisi, Marco</creatorcontrib><creatorcontrib>Troncone, Chiara</creatorcontrib><creatorcontrib>Tari, Daniele U.</creatorcontrib><creatorcontrib>Arcoraci, Vincenzo</creatorcontrib><creatorcontrib>Santoro, Domenico</creatorcontrib><creatorcontrib>Russo, Giusi</creatorcontrib><creatorcontrib>Lacava, Viviana</creatorcontrib><creatorcontrib>Caputi, Achille P.</creatorcontrib><title>The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy</title><title>Clinical drug investigation</title><addtitle>Clin Drug Investig</addtitle><addtitle>Clin Drug Investig</addtitle><description>Background and Objectives
Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antidiabetic drug use in DKD patients from Southern Italy.
Methods
The Arianna database from Caserta Local Health Unit was used. Diabetic patients with incident CKD [first diagnosis date: index date (ID)] were identified by searching for specific ICD9-CM codes among hospital discharge diagnoses/procedures and/or indication of use associated with drug prescriptions. To evaluate any change in the use of antidiabetic drugs after the CKD diagnosis, the prevalence of antidiabetic drug use among DKD patients was calculated within 1 year prior to/after ID and after dialysis entry. A Kaplan–Meier analysis was used to assess the time to discontinuation of antidiabetic drugs after CKD diagnosis. The frequency of antidiabetic drugs contraindicated in renal disease in DKD patients was measured.
Results
Overall, 725 diabetic patients (mean age 72.8 ± 11.4 years) had incident CKD from 2006 to 2011. The use of combination antidiabetic drugs, biguanides and sulphonamides decreased by approximately 10, 7 and 5 %, respectively, after the ID. The use of insulins increased by 10 % after the ID and by 20 % after entry into dialysis. The use of antidiabetic drugs not contraindicated in CKD decreased marginally after the diagnosis of CKD.
Conclusion
In a general practice of Southern Italy the management of diabetes mellitus changed only marginally in newly diagnosed CKD patients, suggesting a therapeutic inertia on the part of prescribers.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Diabetic Nephropathies - physiopathology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Insulin - therapeutic use</subject><subject>Internal Medicine</subject><subject>Italy - epidemiology</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Research Article</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Prevalence</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Retrospective Studies</subject><issn>1173-2563</issn><issn>1179-1918</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU1PXCEUhomxqVb7A7ppSNx0Q8uHwMWdnX6ZajTRrgmXe66DuQNT4MbMvy_TsU1j0hWE87zvOYcXoTeMvmeU6g_llHLFCGWSUKE0UXvokDFtCDOs2_99F4RLJQ7Qq1IeKGWKKf4SHXClDKe0O0SPd0vAVy66e1hBrDiN-FNwPVQo-AqmKdS54BDxjauh1Qt-DHWJF8ucYvD4exgibJqigCtwhs_xTVrPU2NTJB_b04Bv6zxstg63aa5LyBFfVDdtjtGL0U0FXj-dR-jHl893i2_k8vrrxeL8kniheSVjp4E6LxwfjHFUSi7AMd92HHvfGymM0YPvpHcOjDHd2ItBejNyUBJGIcQRerfzXef0c4ZS7SoU3xZzEdJcLNNKU6Xb7zX05Bn6kOYc23SN0sZIw_mWYjvK51RKhtGuc1i5vLGM2m0qdpeKbanYbSpWNc3bJ-e5X8HwV_EnhgbwHVBaKd5D_qf1f11_AcA1l9A</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Trifirò, Gianluca</creator><creator>Parrino, Fabrizio</creator><creator>Pizzimenti, Valeria</creator><creator>Giorgianni, Francesco</creator><creator>Sultana, Janet</creator><creator>Muscianisi, Marco</creator><creator>Troncone, Chiara</creator><creator>Tari, Daniele U.</creator><creator>Arcoraci, Vincenzo</creator><creator>Santoro, Domenico</creator><creator>Russo, Giusi</creator><creator>Lacava, Viviana</creator><creator>Caputi, Achille P.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160301</creationdate><title>The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy</title><author>Trifirò, Gianluca ; Parrino, Fabrizio ; Pizzimenti, Valeria ; Giorgianni, Francesco ; Sultana, Janet ; Muscianisi, Marco ; Troncone, Chiara ; Tari, Daniele U. ; Arcoraci, Vincenzo ; Santoro, Domenico ; Russo, Giusi ; Lacava, Viviana ; Caputi, Achille P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-f87e0ac3a2d99a05523ea1c179fbcb953997dc85caae9998fb3d5c9f2e65ef333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Diabetic Nephropathies - physiopathology</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Insulin - therapeutic use</topic><topic>Internal Medicine</topic><topic>Italy - epidemiology</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Research Article</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Prevalence</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trifirò, Gianluca</creatorcontrib><creatorcontrib>Parrino, Fabrizio</creatorcontrib><creatorcontrib>Pizzimenti, Valeria</creatorcontrib><creatorcontrib>Giorgianni, Francesco</creatorcontrib><creatorcontrib>Sultana, Janet</creatorcontrib><creatorcontrib>Muscianisi, Marco</creatorcontrib><creatorcontrib>Troncone, Chiara</creatorcontrib><creatorcontrib>Tari, Daniele U.</creatorcontrib><creatorcontrib>Arcoraci, Vincenzo</creatorcontrib><creatorcontrib>Santoro, Domenico</creatorcontrib><creatorcontrib>Russo, Giusi</creatorcontrib><creatorcontrib>Lacava, Viviana</creatorcontrib><creatorcontrib>Caputi, Achille P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical drug investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trifirò, Gianluca</au><au>Parrino, Fabrizio</au><au>Pizzimenti, Valeria</au><au>Giorgianni, Francesco</au><au>Sultana, Janet</au><au>Muscianisi, Marco</au><au>Troncone, Chiara</au><au>Tari, Daniele U.</au><au>Arcoraci, Vincenzo</au><au>Santoro, Domenico</au><au>Russo, Giusi</au><au>Lacava, Viviana</au><au>Caputi, Achille P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy</atitle><jtitle>Clinical drug investigation</jtitle><stitle>Clin Drug Investig</stitle><addtitle>Clin Drug Investig</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>36</volume><issue>3</issue><spage>203</spage><epage>212</epage><pages>203-212</pages><issn>1173-2563</issn><eissn>1179-1918</eissn><abstract>Background and Objectives
Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antidiabetic drug use in DKD patients from Southern Italy.
Methods
The Arianna database from Caserta Local Health Unit was used. Diabetic patients with incident CKD [first diagnosis date: index date (ID)] were identified by searching for specific ICD9-CM codes among hospital discharge diagnoses/procedures and/or indication of use associated with drug prescriptions. To evaluate any change in the use of antidiabetic drugs after the CKD diagnosis, the prevalence of antidiabetic drug use among DKD patients was calculated within 1 year prior to/after ID and after dialysis entry. A Kaplan–Meier analysis was used to assess the time to discontinuation of antidiabetic drugs after CKD diagnosis. The frequency of antidiabetic drugs contraindicated in renal disease in DKD patients was measured.
Results
Overall, 725 diabetic patients (mean age 72.8 ± 11.4 years) had incident CKD from 2006 to 2011. The use of combination antidiabetic drugs, biguanides and sulphonamides decreased by approximately 10, 7 and 5 %, respectively, after the ID. The use of insulins increased by 10 % after the ID and by 20 % after entry into dialysis. The use of antidiabetic drugs not contraindicated in CKD decreased marginally after the diagnosis of CKD.
Conclusion
In a general practice of Southern Italy the management of diabetes mellitus changed only marginally in newly diagnosed CKD patients, suggesting a therapeutic inertia on the part of prescribers.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>26692008</pmid><doi>10.1007/s40261-015-0367-6</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Diabetic Nephropathies - physiopathology Female Humans Hypoglycemic Agents - therapeutic use Insulin - therapeutic use Internal Medicine Italy - epidemiology Kaplan-Meier Estimate Male Medicine Medicine & Public Health Middle Aged Original Research Article Pharmacology/Toxicology Pharmacotherapy Prevalence Renal Insufficiency, Chronic - physiopathology Retrospective Studies |
| title | The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy |
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