Pharmacological therapy is important in addressing hyperglycaemia in type 2 diabetes (T2D) but care is required in the presence of renal impairment as pharmacokinetic changes may develop that increase the risk of adverse events. Clear guidance is available to inform safe prescribing of diabetes medicines in renal impairment .
To describe non-insulin anti-hyperglycaemic medication prescribing patterns for people with T2D and renal impairment in Australian general practice and determine whether these conform to safe prescribing guidelines.
A drug utilisation study was conducted using de-identified data from NPS MedicineInsight, an NPS MedicineWise program that collects data from GP clinical software in approximately 500 Australian general practices, representing more than 3.5 million patients. Patients aged ≥ 18y with diagnosis of T2D recorded during September 2012 and September 2015 were included. T2D was identified by any mention of T2D recorded in the diagnosis, history, reason for visit or reason for prescription fields, or prescription of an oral diabetes medicine. Prescriptions for non-insulin anti-hyperglycaemic medicines and eGFR results recorded between 1/10/14 and 1/9/15 were assessed. Prescription appropriateness was determined using current guideline recommendations for medication use in T2D patients with renal impairment .
Preliminary analyses for 105,135 patients in the dataset showed 69,313 (66.0%) were prescribed at least one non-insulin anti-hyperglycaemic medication. The most prevalent medications were metformin (59.9%), gliclazide (16.3%) and sitagliptin (9.2%). eGFR results were available for 56,831 (82.2%) patients. Of these, 10616 (18.7%) had an eGFR<60ml/min/1.73m2 and of these, 5474 (51.6%) received ≥1 inappropriate prescription based on their eGFR. Inappropriate prescriptions commonly involved metformin (65.1%), sitagliptin (14.5%) or glimepiride(4.5%).
Results indicate that prescribing pattern for people with T2D with renal impairment could be further improved. Strategies such as audit and feedback, education and prescribing alerts in the medical record could potentially improve prescribing in this population.