Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice

Y. H. Lee, C. J. Lee, H. S. Lee, E. Y. Choe, B. W. Lee, C. W. Ahn, B. S. Cha, H. C. Lee, B. Balkau, E. S. Kang

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Abstract

Aim: Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D. Methods: A total of 4486 patients treated with either glimepiride or gliclazide for more than 2. years were followed for up to 5.5. years (median: 4.7. years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to. > 132.6. μmol/L (1.5. mg/dL) were also compared. Results: In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95% confidence interval (CI): 0.29-1.12] or doubling of creatinine (HR: 0.74, 95% CI: 0.44-1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate≥60mL/min/1.73m2, HR: 0.21, 95% CI: 0.04-0.99) and good glycaemic control (HbA1c<7%, HR: 0.35, 95% CI: 0.14-0.86), and in older subjects (≥62years, HR: 0.52, 95% CI: 0.27-0.99). Conclusion: In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.

Original languageEnglish
Pages (from-to)208-215
Number of pages8
JournalDiabetes and Metabolism
Volume41
Issue number3
DOIs
Publication statusPublished - 2015 Jun 1

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glimepiride
Gliclazide
Type 2 Diabetes Mellitus
Kidney
Confidence Intervals
Creatinine
Chronic Kidney Failure
Propensity Score
Kidney Diseases

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Lee, Y. H. ; Lee, C. J. ; Lee, H. S. ; Choe, E. Y. ; Lee, B. W. ; Ahn, C. W. ; Cha, B. S. ; Lee, H. C. ; Balkau, B. ; Kang, E. S. / Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice. In: Diabetes and Metabolism. 2015 ; Vol. 41, No. 3. pp. 208-215.
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title = "Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice",
abstract = "Aim: Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D. Methods: A total of 4486 patients treated with either glimepiride or gliclazide for more than 2. years were followed for up to 5.5. years (median: 4.7. years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to. > 132.6. μmol/L (1.5. mg/dL) were also compared. Results: In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95{\%} confidence interval (CI): 0.29-1.12] or doubling of creatinine (HR: 0.74, 95{\%} CI: 0.44-1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate≥60mL/min/1.73m2, HR: 0.21, 95{\%} CI: 0.04-0.99) and good glycaemic control (HbA1c<7{\%}, HR: 0.35, 95{\%} CI: 0.14-0.86), and in older subjects (≥62years, HR: 0.52, 95{\%} CI: 0.27-0.99). Conclusion: In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.",
author = "Lee, {Y. H.} and Lee, {C. J.} and Lee, {H. S.} and Choe, {E. Y.} and Lee, {B. W.} and Ahn, {C. W.} and Cha, {B. S.} and Lee, {H. C.} and B. Balkau and Kang, {E. S.}",
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Lee, YH, Lee, CJ, Lee, HS, Choe, EY, Lee, BW, Ahn, CW, Cha, BS, Lee, HC, Balkau, B & Kang, ES 2015, 'Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice', Diabetes and Metabolism, vol. 41, no. 3, pp. 208-215. https://doi.org/10.1016/j.diabet.2015.01.004

Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice. / Lee, Y. H.; Lee, C. J.; Lee, H. S.; Choe, E. Y.; Lee, B. W.; Ahn, C. W.; Cha, B. S.; Lee, H. C.; Balkau, B.; Kang, E. S.

In: Diabetes and Metabolism, Vol. 41, No. 3, 01.06.2015, p. 208-215.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparing kidney outcomes in type 2 diabetes treated with different sulphonylureas in real-life clinical practice

AU - Lee, Y. H.

AU - Lee, C. J.

AU - Lee, H. S.

AU - Choe, E. Y.

AU - Lee, B. W.

AU - Ahn, C. W.

AU - Cha, B. S.

AU - Lee, H. C.

AU - Balkau, B.

AU - Kang, E. S.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Aim: Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D. Methods: A total of 4486 patients treated with either glimepiride or gliclazide for more than 2. years were followed for up to 5.5. years (median: 4.7. years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to. > 132.6. μmol/L (1.5. mg/dL) were also compared. Results: In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95% confidence interval (CI): 0.29-1.12] or doubling of creatinine (HR: 0.74, 95% CI: 0.44-1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate≥60mL/min/1.73m2, HR: 0.21, 95% CI: 0.04-0.99) and good glycaemic control (HbA1c<7%, HR: 0.35, 95% CI: 0.14-0.86), and in older subjects (≥62years, HR: 0.52, 95% CI: 0.27-0.99). Conclusion: In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.

AB - Aim: Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D. Methods: A total of 4486 patients treated with either glimepiride or gliclazide for more than 2. years were followed for up to 5.5. years (median: 4.7. years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to. > 132.6. μmol/L (1.5. mg/dL) were also compared. Results: In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95% confidence interval (CI): 0.29-1.12] or doubling of creatinine (HR: 0.74, 95% CI: 0.44-1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate≥60mL/min/1.73m2, HR: 0.21, 95% CI: 0.04-0.99) and good glycaemic control (HbA1c<7%, HR: 0.35, 95% CI: 0.14-0.86), and in older subjects (≥62years, HR: 0.52, 95% CI: 0.27-0.99). Conclusion: In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.

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