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Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease
- Source :
- Circulation. Heart failure, vol 9, iss 7
- Publication Year :
- 2016
- Publisher :
- eScholarship, University of California, 2016.
-
Abstract
- Background— Diabetes mellitus, heart failure (HF), and chronic kidney disease are common comorbidities, but overall use and safety of antihyperglycemic medications (AHMs) among patients with these comorbidities are poorly understood. Methods and Results— Using Get With the Guidelines-Heart Failure and linked Medicare Part D data, we assessed AHM use within 90 days of hospital discharge among HF patients with diabetes mellitus discharged from Get With the Guidelines-Heart Failure hospitals between January 1, 2006, and October 1, 2011. We further summarized use by renal function and assessed renal contraindicated AHM use for patients with estimated glomerular filtration rate 2 . Among 8791 patients meeting inclusion criteria, the median age was 77 (interquartile range 71–83), 62.3% were female, median body mass index was 29.7 (interquartile range 25.5–35.3), median hemoglobin A1c was 6.8 (interquartile range 6.2–7.8), and 34% had ejection fraction 2 , 35.4% filled prescriptions for renal contraindicated AHMs per prescribing information, though there was a trend toward lower renal contraindicated AHM use over time (Cochran–Mantel–Haenszel row-mean score test P =0.048). Although use of other AHMs was low overall, thiazolidinediones were used in 6.6% of HF patients, and dipeptidyl peptidase-4 inhibitors were used in 5.1%, with trends for decreasing thiazolidinedione use and increased dipeptidyl peptidase-4 inhibitor use over time ( P Conclusions— Treatment of diabetes mellitus in patients with HF and chronic kidney disease is complex, and these patients are commonly treated with renal contraindicated AHMs, including over 6% receiving a thiazolidinedione, despite known concerns regarding HF. More research regarding safety and efficacy of various AHMs among HF patients is needed.
- Subjects :
- Male
Aging
Kidney Disease
Medical Physiology
heart failure
chronic kidney disease diabetes mellitus
Comorbidity
Practice Patterns
030204 cardiovascular system & hematology
Cardiorespiratory Medicine and Haematology
Kidney
Cardiovascular
0302 clinical medicine
Drug Utilization Review
Interquartile range
Risk Factors
80 and over
Medicine
030212 general & internal medicine
Renal Insufficiency
Practice Patterns, Physicians'
Chronic
Aged, 80 and over
glomerular filtration rate
Ejection fraction
Diabetes
Prognosis
Metformin
Hospitalization
Heart Disease
6.1 Pharmaceuticals
Practice Guidelines as Topic
Disease Progression
Median body
Female
Guideline Adherence
Cardiology and Cardiovascular Medicine
medicine.drug
Glomerular Filtration Rate
medicine.medical_specialty
insulin
Medicare Part D
Renal and urogenital
Renal function
Risk Assessment
Article
03 medical and health sciences
Diabetes mellitus
Internal medicine
Diabetes Mellitus
Humans
Hypoglycemic Agents
Renal Insufficiency, Chronic
Intensive care medicine
Aged
Heart Failure
Physicians'
business.industry
Insurance Benefits
Contraindications
Evaluation of treatments and therapeutic interventions
medicine.disease
United States
Diabetes Mellitus, Type 2
Cardiovascular System & Hematology
Heart failure
Kidney Failure, Chronic
Biochemistry and Cell Biology
business
chronic kidney disease
Kidney disease
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Circulation. Heart failure, vol 9, iss 7
- Accession number :
- edsair.doi.dedup.....32eb8ac7783e8a7ac136212a30d49005