Skip to main content

Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease.

Publication ,  Journal Article
Patel, PA; Liang, L; Khazanie, P; Hammill, BG; Fonarow, GC; Yancy, CW; Bhatt, DL; Curtis, LH; Hernandez, AF
Published in: Circ Heart Fail
July 2016

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 <30 mL/min/1.73m(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 <40%. 74.9% of patients filled a prescription for an AHM, with insulin (39.5%), sulfonylureas (32.4%), and metformin (17%) being the most commonly used AHMs. Insulin use was higher and sulfonylurea/metformin use was lower among patients with lower renal function classes. Among 1512 patients with estimated glomerular filtration rate <30 mL/min/1.73m(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<0.001). 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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

July 2016

Volume

9

Issue

7

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Prognosis
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Medicare Part D
  • Male
  • Kidney
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Patel, P. A., Liang, L., Khazanie, P., Hammill, B. G., Fonarow, G. C., Yancy, C. W., … Hernandez, A. F. (2016). Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease. Circ Heart Fail, 9(7). https://doi.org/10.1161/CIRCHEARTFAILURE.115.002638
Patel, Priyesh A., Li Liang, Prateeti Khazanie, Bradley G. Hammill, Gregg C. Fonarow, Clyde W. Yancy, Deepak L. Bhatt, Lesley H. Curtis, and Adrian F. Hernandez. “Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease.Circ Heart Fail 9, no. 7 (July 2016). https://doi.org/10.1161/CIRCHEARTFAILURE.115.002638.
Patel PA, Liang L, Khazanie P, Hammill BG, Fonarow GC, Yancy CW, et al. Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease. Circ Heart Fail. 2016 Jul;9(7).
Patel, Priyesh A., et al. “Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease.Circ Heart Fail, vol. 9, no. 7, July 2016. Pubmed, doi:10.1161/CIRCHEARTFAILURE.115.002638.
Patel PA, Liang L, Khazanie P, Hammill BG, Fonarow GC, Yancy CW, Bhatt DL, Curtis LH, Hernandez AF. Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease. Circ Heart Fail. 2016 Jul;9(7).

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

July 2016

Volume

9

Issue

7

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Prognosis
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Medicare Part D
  • Male
  • Kidney