Objectives
Chronic kidney disease is often associated with type II diabetes mellitus (T2DM). Patients with T2DM and chronic renal failure are at higher risk of developing hypoglycemia or metabolic acidosis. The purpose of this study was to identify treatment patterns in T2DM patients with chronic renal failure and to estimate the risk of developing complications.
Methods
This study examined data on patients covered by the Quebec provincial drug reimbursement program (RAMQ) who had a diagnosis of diabetes, had used a hypoglycemic agent, and had a diagnosis of chronic renal disease in the period from January 2005 to December 2010. A 1:1 control group of patients with diabetes and without renal disease, matched for age and gender, was also created. Patients' characteristics and drug utilization patterns were analyzed and the risks of experiencing hypoglycemia or metabolic acidosis were estimated.
Results
A total of 4889 patients who had a diagnosis of diabetes with chronic renal failure were included in this cohort. Average age was 69.2 years (SD=10.1) and the proportion of men was slightly higher (54.4%). The hypoglycemia incidence was higher in patients with than without renal insufficiency (10.8% vs. 3.6%; p<0.001). Similarly, the metabolic acidosis incidence was higher in patients with than without renal insufficiency (1.9% vs. 0.9%; p<0.001). Renal insufficiency in diabetic patients was associated with increased hypoglycemia [OR: 3.3 (95% CI: 2.8 – 3.9)], and metabolic acidosis [OR: 2.2 (95% CI: 1.5 – 3.2)].
Conclusions
A significant proportion of diabetic patients with chronic renal failure experienced hypoglycemia or metabolic acidosis. Treatment strategies for these patients that minimize the risk of these complications should be considered.
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© 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
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