Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the U.S. and 40% of affected people develop chronic kidney disease (CKD). This study evaluated patients’ treatment patterns, disease burden and progression.
Methods: This retrospective study used the U.S. claims database PharMetrics Plus (January 2006-December 2015) and the Experian consumer data asset (January 2007-December 2015) to evaluate longitudinal treatment patterns in patients with T2DM and CKD using ICD codes. In addition, CKD progression, all-cause mortality rate, clinical events and health care costs were described.
Results: Of 250,742 patients identified, the median age was 61 years, 58% were male, 73% were Caucasian and 87% had hypertension. Proportions of patients using angiotensin II receptor blockers (ARB) or angiotensin-converting-enzyme inhibitors (ACEi) was lower in CKD stages 4 and 5 (54 and 52%, respectively) than in stages 1-3 (66-70%). The use of beta blockers (32-52%), calcium channel blockers (27-41%) and diuretics (37-54%) tended to increase from CKD stages 1 to 4 and decreased in stage 5. Antidiabetic drugs were prescribed to 65.7% of patients and their use decreased with increasing CKD stage. Of the 21% of patients who progressed within a year to a more severe CKD stage, the highest proportion advanced from stage 4 to 5 (42%). The most common clinical events were diabetic retinopathy, heart failure and acute kidney injury reported in 27%, 22% and 22% of patients, respectively. Overall, 4.6% died with a median time from index to death of 12.3 months. The annual health care costs of $46,028 per person included $9,103 and $36,925 for pharmacy and medical costs, respectively.
Conclusions: The treatment of T2DM patients with CKD was mostly in line with current guideline recommendations. However, only up to 70% of patients used ARB and ACEi, the first line treatments. In addition, 21% of patients progressed to a more severe CKD stage. These findings suggest a need for new treatment options in this population.
M. Blankenburg: None. C.P. Kovesdy: Consultant; Self; Abbott. Advisory Panel; Self; AbbVie Inc.. Consultant; Self; Bayer AG. Advisory Panel; Self; AstraZeneca. Consultant; Self; Sanofi Genzyme. Advisory Panel; Self; Amgen Inc.. Consultant; Self; Keryx. S. Eisenring: None. A. Fett: Consultant; Self; IQVIA. E.W. Schokker: None. J. Korn: None. A. Gay: Employee; Self; Bayer AG.