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Li, YJ., Chang, YL., Chou, YC. et al. Hypoglycemia risk with inappropriate dosing of glucose-lowering drugs in patients with chronic kidney disease: a retrospective cohort study. Sci Rep 13, 6373 (2023). https://doi.org/10.1038/s41598-023-33542-z
Introduction
This study looked at the effects of inappropriate dosing of glucose-lowering drugs in patients with both chronic kidney disease (CKD) and diabetes. CKD is a condition where the kidneys are damaged and cannot function properly, causing a buildup of waste and fluids in the body; diabetes makes it hard for your body to use sugar (glucose) for energy. This happens because your body either doesn’t make enough insulin or can’t use it properly. Insulin is like a key that unlocks your cells to let sugar in. Without enough insulin, sugar builds up in your blood and can cause health problems like kidney damage. The study found that nearly a third of outpatient visits included inappropriate dosing, which increased the risk of hypoglycemia. Hypoglycemia is when blood sugar drops below normal levels, which can cause symptoms like shaking, sweating, and confusion. Treatment usually involves consuming foods or drinks that contain sugar. While hypoglycemia may seem like a common and manageable condition, it can actually be quite scary and dangerous. When blood sugar drops too low, it can cause confusion, seizures, and even loss of consciousness, which can lead to serious accidents or injuries. In severe cases, hypoglycemia can also cause permanent damage to the brain or other organs. This risk was consistent across patients with different levels of kidney function.
Methods
The study defined inappropriate prescriptions for kidney medication doses as doses that were higher than the recommended amount or a condition where the drug is not recommended. The study then classified outpatient visits as either “inappropriate dosing” or “appropriate dosing” based on whether an inappropriate prescription was ordered or not.
Outcomes
The researchers looked at hypoglycemic events, including severe, moderate, and mild hypoglycemia, as well as the occurrence of any hypoglycemic event. Variables that may affect the outcome were assessed, including age, sex, kidney function, average blood sugar levels, likelihood of surviving the next ten years, number of previous severe hypoglycemic events, and number of glucose-lowering drugs being used by the patients.
The study found that the prescription of inappropriate doses of glucose-lowering drugs was associated with an increased risk of hypoglycemia in patients with type 2 diabetes and chronic kidney disease. The researchers recommend careful monitoring of kidney function when prescribing glucose-lowering drugs to reduce the risk of hypoglycemia.
Summary
The study looked at patients who were taking glucose-lowering drugs to manage their diabetes. The researchers found that about 29% of these patients were receiving doses of these drugs that were not appropriate for their age, kidney function, or the number of glucose-lowering drugs they were taking.
The study also found that patients who were receiving inappropriate doses were typically older, had worse kidney function, and were taking more glucose-lowering drugs than those who were receiving appropriate doses.
Overall, these findings suggest that inappropriate dosing of glucose-lowering drugs is common among diabetic patients and that certain patient characteristics and drug prescriptions are associated with higher rates of inappropriate dosing. The association between inappropriate dosing and higher hypoglycemia risk was significant for all categories of hypoglycemia, including severe, moderate, and mild.
These findings suggest that prescribing appropriate doses of glucose-lowering drugs is important for reducing the risk of hypoglycemia in patients with type 2 diabetes, which can be achieved through special safeguards, such as guided drug dosing and pharmacist-based interventions.
Works Cited
CDC. “Chronic Kidney Disease Basics | Chronic Kidney Disease Initiative | CDC.” Www.cdc.gov, 28 Feb. 2022, http://www.cdc.gov/kidneydisease/basics.html Accessed 24 Apr. 2023.
“Charlson Comorbidity Index (CCI).” MDCalc, http://www.mdcalc.com/calc/3917/charlson-comorbidity-index-cci. Accessed 26 Apr. 2023.
“Low Blood Glucose (Hypoglycemia) | NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia
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