Potential impact of prescribing metformin according to EGFR rather than serum creatinine

Delphine S. Tuot, Feng Lin, Michael G. Shlipak, Vanessa Grubbs, Chi Yuan Hsu, Jerry Yee, Vahakn Shahinian, Rajiv Saran, Sharon Saydah, Desmond E. Williams, Neil R. Powe

Research output: Contribution to journalArticle

Abstract

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 2; contraindicated, 2; 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 forwhommetforminwas likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population. RESULTS Among adultswith sCr above conventional cutoffs,MDRDEGFR ≥45 mL/min/1.73m2 wasmost commonamongmen (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 2. All estimating equations expanded the population of individuals for whommetformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with EGFR 30-44mL/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.

Original languageEnglish (US)
Pages (from-to)2059-2067
Number of pages9
JournalDiabetes Care
Volume38
Issue number11
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

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Metformin
Glomerular Filtration Rate
Creatinine
Serum
Population
Chronic Renal Insufficiency
Epidemiology
Odds Ratio
Cystatin C
Health Services Accessibility
Nutrition Surveys
Self Report
Logistic Models
Safety

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Tuot, D. S., Lin, F., Shlipak, M. G., Grubbs, V., Hsu, C. Y., Yee, J., ... Powe, N. R. (2015). Potential impact of prescribing metformin according to EGFR rather than serum creatinine. Diabetes Care, 38(11), 2059-2067. https://doi.org/10.2337/dc15-0542

Potential impact of prescribing metformin according to EGFR rather than serum creatinine. / Tuot, Delphine S.; Lin, Feng; Shlipak, Michael G.; Grubbs, Vanessa; Hsu, Chi Yuan; Yee, Jerry; Shahinian, Vahakn; Saran, Rajiv; Saydah, Sharon; Williams, Desmond E.; Powe, Neil R.

In: Diabetes Care, Vol. 38, No. 11, 01.11.2015, p. 2059-2067.

Research output: Contribution to journalArticle

Tuot, DS, Lin, F, Shlipak, MG, Grubbs, V, Hsu, CY, Yee, J, Shahinian, V, Saran, R, Saydah, S, Williams, DE & Powe, NR 2015, 'Potential impact of prescribing metformin according to EGFR rather than serum creatinine', Diabetes Care, vol. 38, no. 11, pp. 2059-2067. https://doi.org/10.2337/dc15-0542
Tuot DS, Lin F, Shlipak MG, Grubbs V, Hsu CY, Yee J et al. Potential impact of prescribing metformin according to EGFR rather than serum creatinine. Diabetes Care. 2015 Nov 1;38(11):2059-2067. https://doi.org/10.2337/dc15-0542
Tuot, Delphine S. ; Lin, Feng ; Shlipak, Michael G. ; Grubbs, Vanessa ; Hsu, Chi Yuan ; Yee, Jerry ; Shahinian, Vahakn ; Saran, Rajiv ; Saydah, Sharon ; Williams, Desmond E. ; Powe, Neil R. / Potential impact of prescribing metformin according to EGFR rather than serum creatinine. In: Diabetes Care. 2015 ; Vol. 38, No. 11. pp. 2059-2067.
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abstract = "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 2; contraindicated, 2; 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 forwhommetforminwas likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population. RESULTS Among adultswith sCr above conventional cutoffs,MDRDEGFR ≥45 mL/min/1.73m2 wasmost commonamongmen (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 2. All estimating equations expanded the population of individuals for whommetformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with EGFR 30-44mL/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.",
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T1 - Potential impact of prescribing metformin according to EGFR rather than serum creatinine

AU - Tuot, Delphine S.

AU - Lin, Feng

AU - Shlipak, Michael G.

AU - Grubbs, Vanessa

AU - Hsu, Chi Yuan

AU - Yee, Jerry

AU - Shahinian, Vahakn

AU - Saran, Rajiv

AU - Saydah, Sharon

AU - Williams, Desmond E.

AU - Powe, Neil R.

PY - 2015/11/1

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N2 - 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 2; contraindicated, 2; 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 forwhommetforminwas likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population. RESULTS Among adultswith sCr above conventional cutoffs,MDRDEGFR ≥45 mL/min/1.73m2 wasmost commonamongmen (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 2. All estimating equations expanded the population of individuals for whommetformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with EGFR 30-44mL/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.

AB - 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 2; contraindicated, 2; 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 forwhommetforminwas likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population. RESULTS Among adultswith sCr above conventional cutoffs,MDRDEGFR ≥45 mL/min/1.73m2 wasmost commonamongmen (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 2. All estimating equations expanded the population of individuals for whommetformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with EGFR 30-44mL/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.

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