Secular trends in antihyperglycemic medication prescriptions in older adults with diabetes and chronic kidney disease: 2004-2013

Aim — To examine how antihyperglycemic medications were prescribed to older adults with diabetes and chronic kidney disease over the last decade.

Materials and Methods — We conducted a population-based study of 144 252 older adults with diabetes and chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m² or on chronic dialysis) in Ontario, Canada. In each study quarter (3-month intervals from April 1 2004 until March 31 2013) we studied the proportion of treated and newly treated patients prescribed insulin, sulphonylureas, alpha-glucosidase inhibitors, metformin, thiazolidinediones, meglitinides, and dipeptidyl peptidase-4 inhibitors. We further examined prescription trends by stage of chronic kidney disease.

Results — The mean age of patients increased slightly (from 76 to 78 years) over the study period and the percentage with comorbidities declined. Metformin was the predominant therapy prescribed (prescribed to a mean of 56.1% of treated patients). Glyburide (glibenclamide) and thiazolidinedione prescriptions decreased (glyburide prescriptions declined from 45.5% to 9.5%, rosiglitazone 3.6% to 0.2%, pioglitazone 1.9% to 1.7%), while gliclazide and dipeptidyl peptidase-4 inhibitor prescriptions increased (gliclazide prescriptions increased from 0.6% to 26.4%, sitagliptin from 0% to 15.3%, saxagliptin from 0% to 2.0%). Up to 48.6% of patients with stage 3a to 5 chronic kidney disease or on chronic dialysis were prescribed glyburide, and up to 27.6% with stage 4 to 5 disease or on chronic dialysis were prescribed metformin.

Conclusions — In patients with chronic kidney disease, there were trends towards safer antihyperglycemic medication prescribing. A considerable number of patients, however, continue to receive medications that should be avoided.