Background: Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice\npatterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic\ncontrol. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large\ncontemporary prospective cohort of patients with diabetes and CKD.\nMethods: The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18ââ?¬â??74 years with an\nestimated glomerular filtration rate (eGFR) between 30ââ?¬â??60 mL/min/1.73 m2 or proteinuria >0.5 g/d. The use of diet\nprescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the\nmain outcome measure.\nResults: At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25thââ?¬â??75th\npercentile: 6.8ââ?¬â??7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral\nantidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was\nused by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase\nof 1 kg/m2, 95 % CI 1.02ââ?¬â??1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04ââ?¬â??1.18), treatment with insulin\nalone (OR = 5.63, 95 % CI 4.26ââ?¬â??7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77ââ?¬â??6.46) but\nnot monotherapy with metformin, DPP-4 inhibitors, or glinides.\nConclusions: Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment\npatterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies.\nMetabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels
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