Prescribing for people with type 2 diabetes and renal impairment in Australian general practice: A national cross sectional study

Abstract

Aim: To determine whether the prescribing of non-insulin anti-hyperglycaemic medications in Australian general practice is consistent with current guidelines for treatment of type 2 diabetes (T2D) in people with renal impairment.

Methods: Cross-sectional study of 9624 people with T2D in the NPS MedicineInsight dataset aged≥18years with average estimated glomerular filtration rate (eGFR) <60ml/min/1.73m² and prescribed at least one non-insulin anti-hyperglycaemic medication from October 2014 to September 2015. The primary outcome was the proportion of non-insulin anti-hyperglycaemic medications prescribed at doses inconsistent with current guidelines.

Results: 4650 (48.3%) patients were prescribed at least one non-insulin anti-hyperglycaemic medication at a dose inconsistent with Australian Diabetes Society guidelines. The majority (88.0%) had an average eGFR of 30-59ml/min/1.73m². Metformin was the most frequently prescribed agent (n=7408; 77.0%), and was prescribed at a dose inconsistent with guidelines for 52% of patients. 123/136 (90.5%) people prescribed a sodium glucose co-transporter 2 inhibitor and 1114/2194 (50.8%) prescribed a dipeptidyl peptidase-4 inhibitor were prescribed a dose inconsistent with guidelines. Decreasing age, being male or being on insulin was associated with greater odds of at least one prescription inconsistent with guidelines.

Conclusion: Nearly half of people with T2D and renal impairment were prescribed a non-insulin anti-hyperglycaemic medication at a dose inconsistent with current Australian guidelines, the majority of whom had an eGFR consistent with stage 3 chronic kidney disease.

Keywords: Diabetes; Electronic health records; General practice; MedicineInsight; Prescribing; Renal impairment.