Antihyperglycemic treatment in patients with type 2 diabetes in Italy: the impact of age and kidney function

// Sandro Gentile 1 , Pamela Piscitelli 2 , Francesca Viazzi 3 , Giuseppina Russo 4 , Antonio Ceriello 5, 6 , Carlo Giorda 7 , Piero Guida 8 , Paola Fioretto 9 , Roberto Pontremoli 3 , Felice Strollo 10 , Salvatore De Cosmo 2 and The AMD-Annals Study Group 11 1 Department of Clinical and Experimental Medicine, University of Campania, Naples, Italy 2 IRCSS Casa Sollievo della Sofferenza – Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, Italy 3 Università degli Studi, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy 4 Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy 5 Insititut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain 6 U.O. Diabetologia e Malattie Metaboliche, Multimedica IRCCS, Milano, Italy 7 Diabetes and Metabolism Unit, ASL Turin 5, Turin, Italy 8 Statistical Consultant for Associazione Medici Diabetologi (AMD), Rome, Italy 9 Department of Medicine, University of Padova, Padova, Italy 10 Endocrinology and Metabolism, Elle-di, Rome, Italy 11 Associazione Medici Diabetologi (AMD), Rome, Italy Correspondence to: Salvatore De Cosmo, email: sdecosm@tin.it Sandro Gentile, email: s.gentile1949@gmail.com Keywords: type 2 diabetes mellitus, nephropathy, age, antihyperglycemic treatment, eGFR Received: May 03, 2017     Accepted: May 10, 2017     Published: June 28, 2017 ABSTRACT We describe AHA utilization pattern according to age and renal function in type 2 diabetes mellitus (T2DM), in real-life conditions. The analysis was performed using the data set of electronic medical records collected between 1 January and 31 December, 2011 in 207 Italian diabetes centers. The study population consisted of 157,595 individuals with T2DM. The AHA treatment regimens was evaluated. Kidney function was assessed by eGFR, estimated using the CKD-EPI formula. Other determinations: HbA1c, blood pressure (BP), low- density lipoprotein (LDL-c), total and high density lipoprotein cholesterol (TC and HDL-c), triglycerides (TG) and serum uric acid (SUA). Quality of care was assessed through Q score. The proportion of subjects taking metformin declined progressively across age quartiles along with eGFR values, but remained high in oldest subjects (i.e. 54.5 %). On the other hand, the proportion of patients on secretagogues or insulin increased with aging (i.e. 54.7% and 37% in the fourth age quartile, respectively). The percentage of patients with low eGFR (i.e. <30 ml/min/1.73m2) taking either metformin or sulphonilureas/repaglinide was particularly high (i.e. 15.3% and 34.3% respectively). In a large real-life cohort of T2DM, metformin or sulphonylureas/repaglinide, although not recommended, are frequently prescribed to elderly subjects with severe kidney disease.