Metformin eligibility expanded with use of eGFR.
Use of estimated glomerular filtration rate (eGFR) rather than serum creatinine (sCr) can expand metformin eligibility, according to a study published in the November issue of Diabetes Care. Delphine S. Tuot, M.D., from the University of California in San Francisco, and colleagues examined the potential impact of recommendations to use eGFR rather than sCr to determine metformin eligibility. Metformin eligibility was examined among 3,902 adults with diabetes from the 1999 to 2010 National Health and Nutrition Examination Surveys using conventional sCr thresholds and eGFR categories. Different eGFR equations were used to estimate creatinine clearance (CrCl), including four-variable Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine (CKD-EPIcr), and CKD-EPI cystatin C, as well as Cockcroft-Gault (CG). The researchers found that MDRD eGFR ≥45 mL/min/1.73 m² was most common for men and non-Hispanic blacks among adults with sCr above conventional cut-offs (adjusted odds ratios, 33.3 versus women and 14.8 versus whites, respectively). An MDRD eGFR <30 mL/min/1.73 m² was not seen among individuals with sCr below conventional cut-offs. The population of individuals for whom metformin is likely safe was expanded with all estimating equations, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). "The use of eGFR or CrCl to determine metformin eligibility instead of sCr can expand the adult population with diabetes for whom metformin is likely safe, particularly among non-Hispanic blacks and men," the authors write. From http://www.physiciansbriefing.com
Nyhetsinfo Abstract Potential Impact of Prescribing Metformin According to eGFR Rather Than Serum Creatinine
OBJECTIVE Many societies recommend using estimated glomerular filtration rate (eGFR) rather than serum creatinine (sCr) to determine metformin eligibility. We examined the potential impact of these recommendations on metformin eligibility among U.S. adults. RESEARCH DESIGN AND METHODS Metformin eligibility was assessed among 3,902 adults with diabetes who participated in the 1999–2010 National Health and Nutrition Examination Surveys and reported routine access to health care, using conventional sCr thresholds (eligible if <1.4 mg/dL for women and <1.5 mg/dL for men) and eGFR categories: likely safe, ≥45 mL/min/1.73 m2; contraindicated, <30 mL/min/1.73 m2; and indeterminate, 30–44 mL/min/1.73 m2). Different eGFR equations were used: four-variable MDRD, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine (CKD-EPIcr), and CKD-EPI cystatin C, as well as Cockcroft-Gault (CG) to estimate creatinine clearance (CrCl). Diabetes was defined by self-report or A1C ≥6.5% (48 mmol/mol). We used logistic regression to identify populations for whom metformin was likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population. RESULTS Among adults with sCr above conventional cutoffs, MDRD eGFR ≥45 mL/min/1.73 m2 was most common among men (adjusted odds ratio [aOR] 33.3 [95% CI 7.4–151.5] vs. women) and non-Hispanic Blacks (aOR vs. whites 14.8 [4.27–51.7]). No individuals with sCr below conventional cutoffs had an MDRD eGFR <30 mL/min/1.73 m2. All estimating equations expanded the population of individuals for whom metformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with eGFR 30–44 mL/min/1.73 m2, for whom metformin safety is indeterminate, ranging from 784,700 (CKD-EPIcr) to 1,636,000 (CG). CONCLUSIONS The use of eGFR or CrCl to determine metformin eligibility instead of sCr can expand the adult population with diabetes for whom metformin is likely safe, particularly among non-Hispanic blacks and men. www red DiabetologNytt |