Introduction:
Though recent guidelines unanimously advocate the usage of SGLT-2 inhibitors (SGLT-2i), in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), various assessments across the world show that only 6% ( US [NHANES]) to 32.9% (Korea) of those eligible are currently on these drugs.
Methods:
A multi-centre cross sectional prospective study was conducted to assess various parameters of CKD amongst T2D patients across India based on estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). Three distinct patterns of CKD were included for the analysis (CKD A: eGFR <60 ml/min without albuminuria, CKD B: albuminuria with eGFR >=60ml/min, and CKD C: eGFR <60 ml/min and albuminuria). A descriptive and analytical multivariate logistic regression analysis was undertaken to assess drug usage complaint to the recent CKD guidelines.
Results:
A total of 1,153 patients with CKD screened from 12,913 consecutive patients with T2D were included for analysis. DATAtab: Online Statistics Calculator and Minitab statistical software 21 were used to conduct the analysis. Amongst the recommended reno-protective agents, 70.87% were on a SGLT-2i, 62.58% on a RASSB, and 8.47% on NS-MRA. In patients with hypertension (HT) and albuminuria 76.22 % were on RAAS blockage and 72.09% were on SGLT-2i, and in those with albuminuria without HT, 62.87% were on a SGLT-2i and 20.25% were on RAASB.
The multivariate logistic regression analysis indicated a greater propensity to prescribe SGLT-2i (OR 0.82, 95% CI 1.36-3.77) in patients with CKD category A, RAASB (OR 1.91, 95% CI 1.08-3.38) and non-steroidal mineralocorticoid antagonist (NS-MRA) (OR 10.48, 95% CI 4.86-22.57) in those with CKD category B (UACR>300 mg). In advanced CKD (category C) there was an expected reduction in the use of metformin and TZD, and an increased odds of prescribing NS-MRA, loop diuretics, calcium channel blockers (CCB), and insulin. (Table 1)
Conclusions:
This study reassuringly indicates that a significant number of patients from India with T2D and CKD are treated as per international recommendations, with adequate usage of SGLT-2 inhibitors, alongside RAASB, in contrast to data from across the world.
Table 1: Prescription propensity in T2D according to different stages of CKD.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.