Glucose-Lowering Medication Use in CKD: Analysis of US Medicare Beneficiaries Between 2007 and 2016
Open accessAbstract
BACKGROUND: Information regarding the use of glucose-lowering medications in patients with chronic kidney disease (CKD) is limited. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Medicare 5% random sample of patients with CKD with type 2 diabetes, 2007 to 2016. PREDICTORS: Study year, CKD stage, low-income subsidy status, and demographic characteristics (age, sex, and race/ethnicity). OUTCOMES: Trends in use of glucose-lowering medications. ANALYTICAL APPROACH: Yearly cohorts of patients with CKD and type 2 diabetes were created. Descriptive statistics were used to report proportions of patients using glucose-lowering medications. To test overall trends in glucose-lowering medication classes, linear probability models with adjustment for age, sex, race/ethnicity, CKD stage, and low-income subsidy status were used. RESULTS: Metformin use increased significantly from 32.7% in 2007 to 48.7% in 2016. Use of newer classes of glucose-lowering medications increased significantly, including dipeptidyl peptidase 4 inhibitors (5.6%, 2007; 21.7%, 2016), glucagon-like peptide 1 receptor agonists (2.3%, 2007; 6.1%, 2016), and sodium-glucose cotransporter 2 inhibitors (0.2%, 2013; 3.3%, 2016). Newer insulin analogue use increased from 37.2% in 2007 to 46.3% in 2013 and then remained steady. Use of sulfonylureas, thiazolidinediones, older insulins (human regular and neutral protamine Hagedorn), α-glucosidase inhibitors, amylin mimetics, and meglitinides decreased significantly. Insulin was the most highly used single medication class. Insulin use was higher among low-income subsidy than among non-low-income subsidy patients. Combination therapy was less common as CKD stage increased. LIMITATIONS: Patients with CKD and type 2 diabetes and the CKD stages were identified with diagnosis codes and could not be verified through medical record review. Our results may not be generalizable to younger patients with CKD with type 2 diabetes. CONCLUSIONS: Use of metformin and newer glucose-lowering medication classes is increasing in patients with CKD with type 2 diabetes. We anticipate that percentages of patients with CKD using these newer agents will increase.
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Large clinical trials have shown benefits of newer glucose-lowering medications on cardiovascular and kidney outcomes in patients with CKD with type 2 diabetes.
“Large clinical trials have shown benefits of newer glucose-lowering medications on cardiovascular and kidney outcomes in patients with CKD with type 2 diabetes.5, 6, 7, 8, 9, 10, 11, 12, 13, 14”
From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [14]
The Discussion (page unavailable) reports that trials of empagliflozin and canagliflozin found cardiovascular and kidney benefits in patients with type 2 diabetes, and that a dulaglutide trial found kidney benefits in patients with type 2 diabetes and CKD. It does not clearly report both cardiovascular and kidney benefits specifically in the CKD trial populations, so the claim’s population-specific wording is broader than the reported findings. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe clinical trials that may have impacted our results were CANVAS, EMPA-REG OUTCOME, SUSTAIN-6, and LEADER, all of which demonstrated significant cardiovascular and kidney benefits of SGLT-2i and GLP-1RA.
“The clinical trials that may have impacted our results were the CANVAS (canagliflozin, published 2017), EMPA-REG OUTCOME (empagliflozin, 2015), the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6) trial (semaglutide, 2016), and the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEAD”
From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [14]
The Discussion (page not provided) reports cardiovascular and kidney benefits from EMPA-REG OUTCOME, CANVAS, and LEADER. It does not discuss SUSTAIN-6 trial outcomes or establish that these trials affected the citing authors’ results; its mention of semaglutide concerns FDA approval in 2019. (LLM, conf=0.86)
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- Authors
- Zhao, J. Z., Weinhandl, E. D., Carlson, A. M., & St. Peter, W. L.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Zhao, Julie Z.
- ORCID
- Weinhandl, Eric D.
- Venue
- Kidney Medicine
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 3
- Issue
- 2
- Pages
- 173-182.e1
- ISSN
- 2590-0595 (ISSN-L)
- PMC
- PMC8039422
- OpenAlex
- W3116856823
- Semantic Scholar
- 34686a4af2c788d9f2a59dd73563a791ae176b8a
- Cited by
- 9
- References
- 37
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 2
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Kidney Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, glucose-lowering medications, metformin, SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, insulin, sulfonylureas, thiazolidinediones, combination therapy, low-income subsidy, Medicare beneficiaries, medication trends, CKD stage, insulin resistance, insulin sensitivity
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