(B-043) Use Of Antidiabetic Agents In Type 2 Diabetes Mellitus Patients With Chronic Kidney Disease At A Teaching And Referral Hospital In Western Kenya

Background: Diabetes mellitus is a major cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD), increasing morbidity and mortality. Effective glycemic control is essential, yet many anti diabetic agents require dosage adjustments to prevent adverse effects such as hypoglycaemia and lactic acidosis. Despite guidelines, adherence to these modifications remains inconsistent, leading to suboptimal patient outcomes. This study examines the frequency of dosage adjustments at a Teaching and Referral Hospital and their impact on glycemic control.

Objectives: To determine the frequency of anti diabetic dosage adjustments in type 2 diabetes mellitus (T2DM) patients with CKD at a Teaching and Referral Hospital in Western Kenya and assess the impact on glycemic control.

Methods: A six-month cross-sectional study was conducted at the hospital adult medical wards and renal clinic in Western Kenya. A census sampling approach was used to recruit all eligible T2DM patients with CKD. Data were collected from patient records and structured questionnaires, capturing demographics, medication use, kidney function (eGFR), and glycemic control (HbA1c). Inclusion criteria was T2DM patients diagnosed with CKD, while those with acute kidney injury were excluded. Kidney function was categorised using eGFR values. Drug interactions were assessed using Micromedex and UpToDate applications. The primary outcome was the frequency of anti diabetic dosage adjustments, while secondary outcomes included glycemic control and hypoglycaemia prevalence. Descriptive statistics were reported as means with standard deviations (SD) for continuous variables and proportions for categorical variables.

Results: Among 235 T2DM patients, 91 (38.7%) had CKD, with a mean age of 57.8 ± 11.8 years; 58.2% were male. The mean eGFR was 19.4 (SD 13.6), with 46.2% in stage 5 and 35.2% in stage 4. The most commonly used agents were mixtard insulin (60.4%), metformin (25.3%), and glibenclamide (11%). Dosage adjustments were required in 85 (93.4%) patients but implemented in only 37 (43.5%). Glycemic control (HbA1c 6.5-8%) was achieved in 15 (16.5%) patients. Hypoglycaemia symptoms were reported in 84 (92.3%), with a mean HbA1c of 10.16% (SD 2.41). Drug interactions were noted in 64 (88.8%) of 72 patients on additional medications.

Conclusions: Most T2DM patients with CKD did not receive necessary dosage adjustments, contributing to poor glycemic control. Routine anti diabetic dosage adjustments should be a standard component of T2DM-CKD management to improve glycemic outcomes and minimize adverse effects.