Hypoglycemia risk high among older, Black patients with CKD, type 2 diabetes
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Risk for hypoglycemia is higher among older Black adults with chronic kidney disease and type 2 diabetes compared with white patients, according to data published in Kidney Medicine.
Further, investigators identified a correlation between the reduced risk of hypoglycemia and SGLT2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) independent of age, gender, race/ethnicity, baseline medication use, CKD stage and comorbidity conditions.
“There is limited information on safety issues of newer glucose-lowering medications from a large population perspective in CKD patients with type 2 diabetes. Additionally, there is no information on comparative hypoglycemia risk in different race, age, gender or socioeconomic groups,” Julie Z. Zhao MPH, PhD, from the department of pharmaceutical care and health system in the college of pharmacy at the University of Minnesota, and colleagues wrote. “Our study aimed to examine hypoglycemia risk associated with second-generation sulfonylureas [vs.] SGLT2i or GLP-1RA, in a general population of older patients with CKD and type 2 diabetes, across race, age, gender and socioeconomic subgroups.”
In a retrospective cohort, researchers examined data for 18,567 adults with CKD and type 2 diabetes who filled a first prescription of a sulfonylurea (n=16,039), SGLT2i or GLP-1RA (n=2,528) between Jan. 1, 2013, and Sept. 30, 2018. Data were derived from a 20% random sampled from Medicare fee-for-service claims.
Researchers followed patients from the prescription index date until the first hypoglycemia event, death or censoring events, such as completion of a 90-day follow-up.
Using Cox proportional hazard models, researchers measured the 90-day risk of hypoglycemia linked to SGLT2i or GLP-1RA vs. sulfonylureas.
Analyses revealed use of SGLT2i or GLP-1RA was associated with a significantly lower risk of hypoglycemia compared with use of sulfonylureas. The correlation was independent of age, gender, race/ethnicity, baseline medication use, CKD stage and comorbidities. Additionally, researchers observed Black patients had a higher risk for developing hypoglycemia than white patients. Patients aged 75 to 84 years vs. 65 to 74 years, patients with a low-income subsidy or a higher comorbidity score also showed a higher risk for developing hypoglycemia.
“Importantly, our results demonstrate that Black race was not only associated with lower use of newer agents with demonstrated cardiovascular and kidney benefits and lower hypoglycemia risk, but also with a higher rate of hypoglycemia events as compared to white patients,” Zhao and colleagues wrote. “These results are a call for action for new policies that eliminate disparities in access and use of these newer agents in Black individuals and those with lower socioeconomic status.”
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