Tags

Type your tag names separated by a space and hit enter

Age, renal dysfunction, cardiovascular disease, and antihyperglycemic treatment in type 2 diabetes mellitus: findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study.
J Am Geriatr Soc. 2013 Aug; 61(8):1253-61.JA

Abstract

OBJECTIVES

To assess the distribution of antihyperglycemic treatments according to age and renal function and its relationship with cardiovascular disease in type 2 diabetes mellitus (T2DM).

DESIGN

Cross-sectional analysis.

SETTING

Nineteen hospital-based diabetes mellitus clinics in 2007 and 2008.

PARTICIPANTS

Fifteen thousand seven hundred thirty-three individuals with T2DM from the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study.

MEASUREMENTS

Current antihyperglycemic treatments were recorded. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Albuminuria was measured using immunonephelometry or immunoturbidimetry. Prevalence of major acute cardiovascular events was calculated according to age quartiles, treatments, and categories of eGFR (1 = ≥90; 2 = 60-89; 3 = 30-59; and 4 = <30 mL/min per 1.73 m(2)).

RESULTS

Across age quartiles, eGFR declined progressively at a time-linear rate, with an acceleration in older adults, whereas albuminuria increased; age and eGFR were associated with cardiovascular events independently of other confounders. With increasing age, percentage of participants using lifestyle treatments for their T2DM and taking metformin or glitazones fell; percentage taking sulphonylureas and repaglinide rose, and percentage taking insulin remained stable. In eGFR categories 3 and 4, use of metformin was 41.4% and 14.5%, respectively, and that of sulphonylureas was 34.2% and 18.1%, respectively. Inappropriate prescription of these agents, especially sulphonylureas, increased with age. Metformin was independently associated with lower prevalence of cardiovascular disease for any age quartile and eGFR category than all other treatments.

CONCLUSION

In real-life conditions, use of agents that are not recommended in elderly adults with diabetes mellitus with moderate to severe renal impairment is frequent, but metformin is associated with lower cardiovascular event rates even in these individuals.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. anna.solini@med.unipi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23889588

Citation

Solini, Anna, et al. "Age, Renal Dysfunction, Cardiovascular Disease, and Antihyperglycemic Treatment in Type 2 Diabetes Mellitus: Findings From the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study." Journal of the American Geriatrics Society, vol. 61, no. 8, 2013, pp. 1253-61.
Solini A, Penno G, Bonora E, et al. Age, renal dysfunction, cardiovascular disease, and antihyperglycemic treatment in type 2 diabetes mellitus: findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study. J Am Geriatr Soc. 2013;61(8):1253-61.
Solini, A., Penno, G., Bonora, E., Fondelli, C., Orsi, E., Trevisan, R., Vedovato, M., Cavalot, F., Cignarelli, M., Morano, S., Ferrannini, E., & Pugliese, G. (2013). Age, renal dysfunction, cardiovascular disease, and antihyperglycemic treatment in type 2 diabetes mellitus: findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study. Journal of the American Geriatrics Society, 61(8), 1253-61. https://doi.org/10.1111/jgs.12381
Solini A, et al. Age, Renal Dysfunction, Cardiovascular Disease, and Antihyperglycemic Treatment in Type 2 Diabetes Mellitus: Findings From the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study. J Am Geriatr Soc. 2013;61(8):1253-61. PubMed PMID: 23889588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Age, renal dysfunction, cardiovascular disease, and antihyperglycemic treatment in type 2 diabetes mellitus: findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study. AU - Solini,Anna, AU - Penno,Giuseppe, AU - Bonora,Enzo, AU - Fondelli,Cecilia, AU - Orsi,Emanuela, AU - Trevisan,Roberto, AU - Vedovato,Monica, AU - Cavalot,Franco, AU - Cignarelli,Mauro, AU - Morano,Susanna, AU - Ferrannini,Ele, AU - Pugliese,Giuseppe, AU - ,, Y1 - 2013/07/26/ PY - 2013/7/30/entrez PY - 2013/7/31/pubmed PY - 2013/10/29/medline KW - age KW - albuminuria KW - cardiovascular disease KW - glomerular filtration rate KW - oral hypoglycemic agents SP - 1253 EP - 61 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 61 IS - 8 N2 - OBJECTIVES: To assess the distribution of antihyperglycemic treatments according to age and renal function and its relationship with cardiovascular disease in type 2 diabetes mellitus (T2DM). DESIGN: Cross-sectional analysis. SETTING: Nineteen hospital-based diabetes mellitus clinics in 2007 and 2008. PARTICIPANTS: Fifteen thousand seven hundred thirty-three individuals with T2DM from the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study. MEASUREMENTS: Current antihyperglycemic treatments were recorded. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Albuminuria was measured using immunonephelometry or immunoturbidimetry. Prevalence of major acute cardiovascular events was calculated according to age quartiles, treatments, and categories of eGFR (1 = ≥90; 2 = 60-89; 3 = 30-59; and 4 = <30 mL/min per 1.73 m(2)). RESULTS: Across age quartiles, eGFR declined progressively at a time-linear rate, with an acceleration in older adults, whereas albuminuria increased; age and eGFR were associated with cardiovascular events independently of other confounders. With increasing age, percentage of participants using lifestyle treatments for their T2DM and taking metformin or glitazones fell; percentage taking sulphonylureas and repaglinide rose, and percentage taking insulin remained stable. In eGFR categories 3 and 4, use of metformin was 41.4% and 14.5%, respectively, and that of sulphonylureas was 34.2% and 18.1%, respectively. Inappropriate prescription of these agents, especially sulphonylureas, increased with age. Metformin was independently associated with lower prevalence of cardiovascular disease for any age quartile and eGFR category than all other treatments. CONCLUSION: In real-life conditions, use of agents that are not recommended in elderly adults with diabetes mellitus with moderate to severe renal impairment is frequent, but metformin is associated with lower cardiovascular event rates even in these individuals. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/23889588/Age_renal_dysfunction_cardiovascular_disease_and_antihyperglycemic_treatment_in_type_2_diabetes_mellitus:_findings_from_the_Renal_Insufficiency_and_Cardiovascular_Events_Italian_Multicenter_Study_ L2 - https://doi.org/10.1111/jgs.12381 DB - PRIME DP - Unbound Medicine ER -