Compliance with Prescription Guidelines for Glucose-Lowering Therapies According to Renal Function: Real-Life Study in Inpatients of Internal Medicine, Endocrinology and Cardiology Units

Background and objectives: Renal failure is a contraindication for some glucose-lowering drugs and requires dosage adjustment for others, particularly biguanides, sulfonylureas, and inhibitors of dipeptidyl peptidase 4. In this study, we assessed adherence to prescription recommendations for glucose...

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Published in:Medicina (Kaunas, Lithuania) Vol. 57; no. 12; p. 1376
Main Authors: Lohan, Laura, Galtier, Florence, Manson, Thibault, Mura, Thibault, Castet-Nicolas, Audrey, Faure, Delinger, Chapet, Nicolas, Leclercq, Florence, Pasquié, Jean Luc, Roubille, François, Roubille, Camille, Blain, Hubert, Guilpain, Philippe, Villiet, Maxime, Avignon, Antoine, Sultan, Ariane, Breuker, Cyril
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 17.12.2021
MDPI
Subjects:
Cardiology
cardiovascular medicine
Contraindications
Diabetes
diabetes mellitus
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Drug dosages
Drug stores
Endocrinology
Endocrinology and metabolism
Geriatrics
Glucose
glucose-lowering drugs
Guideline Adherence
Heart failure
Hospitalization
Hospitals
Human health and pathology
Humans
Hypoglycemia
Hypoglycemic Agents - adverse effects
Inappropriate Prescribing
Inpatients
Insulin
Internal Medicine
Kidney - physiology
Kidney - physiopathology
Kidney diseases
Life Sciences
Medical records
Medicine
Patients
Pharmaceutical sciences
Pharmacology
prescription guidelines
Prospective Studies
renal function
Urology and Nephrology
United States > US
renal function
diabetes mellitus
glucose-lowering drugs
prescription guidelines
cardiovascular medicine
Glucose-lowering drugs
Prescription guidelines
Renal function
Cardiovascular medicine
Diabetes mellitus
ISSN:1648-9144, 1010-660X, 1648-9144
Online Access:Get full text
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Summary:Background and objectives: Renal failure is a contraindication for some glucose-lowering drugs and requires dosage adjustment for others, particularly biguanides, sulfonylureas, and inhibitors of dipeptidyl peptidase 4. In this study, we assessed adherence to prescription recommendations for glucose-lowering drugs according to renal function in hospitalized diabetic subjects. Materials and Methods: This prospective cohort study was carried out over a 2-year period in a university hospital. Glomerular filtration rate (GFR) was determined by averaging all measurements performed during hospitalization. Glucose-lowering drug dosages were analyzed according to the recommendations of the relevant medical societies. Results: In total, 2071 diabetic patients (53% hospitalized in cardiology units) were examined. GFR was <30 mL/min/1.73 m2 in 13.4% of these patients, 30–44 in 15.1%, 45–60 in 18.3%, and >60 in 53.3%. Inappropriate oral glucose-lowering treatments were administered to 273 (13.2%) patients, including 53 (2.6%) with a contraindication. In cardiology units, 53.1% and 14.3% of patients had GFRs of <60 and <30 mL/min/1.73 m2, respectively, and 179 (15.4%) patients had a contraindication or were prescribed an excessive dose of glucose-lowering drugs. Conclusions: We showed that the burden of inappropriate prescriptions is high in diabetic patients. Given the high number of patients receiving these medications, particularly in cardiology units, a search for potential adverse effects related to these drugs should be performed.
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PMCID: PMC8704212
These authors contributed equally to this work.
ISSN:1648-9144
1010-660X
1648-9144
DOI:10.3390/medicina57121376