COMPARISON OF THE EFFECTIVENESS OF ANTIDIABETIC COMBINATION THERAPY WITH AND WITHOUT METFORMIN IN PATIENTS WITH DIABETES MELLITUS AND RENAL IMPAIRMENT AT HOSPITAL X, SURAKARTA
DOI:
https://doi.org/10.54973/jham.v6i2.783Keywords:
type 2 DM, renal impairment, metformin, HbA1cAbstract
Metformin is the first-line therapy for type 2 diabetes mellitus; however, its use in patients with impaired renal function remains controversial. This study aimed to compare the effectiveness of combination antidiabetic therapy with and without metformin in patients with type 2 diabetes mellitus and renal impairment. A cross-sectional retrospective study was conducted using medical records of patients at Hospital X in Surakarta from January to December 2024. Patients with an estimated glomerular filtration rate below 60 mL/min/1.73 m² who received combination antidiabetic therapy for at least three months were selected through purposive sampling. Treatment effectiveness was evaluated based on the achievement of HbA1c levels below 7%. A total of 36 patients met the study criteria. The results showed no significant association between age, sex, comorbidities, or stage of chronic kidney disease and glycemic target achievement. None of the patients receiving metformin achieved the HbA1c target, while some patients in the non-metformin group did, although the difference between the two regimens was not statistically significant (p = 0.076). In conclusion, combination therapy with metformin did not demonstrate superior effectiveness compared to non-metformin combination therapy in this patient population.
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References
Achmad, G. N. V., Yufria, L. N., Rahem, A., & Pristianty, L. (2023). Factors that contribute to blood sugar control in type 2 diabetes mellitus. Pharmacy Education, 23(4), 48–52. https://doi.org/10.46542/pe.2023.234.4852
B Patel, L., & H Raghavani, P. (2020). Renal function impairment and HbA1c level in type 2 diabetes mellitus patients. International Journal of Clinical Biochemistry and Research, 7(1), 120–123. https://doi.org/10.18231/j.ijcbr.2020.024
Baker, C., Retzik-Stahr, C., Singh, V., Plomondon, R., Anderson, V., & Rasouli, N. (2021). Should metformin remain the first-line therapy for treatment of type 2 diabetes? In Therapeutic Advances in Endocrinology and Metabolism (Vol. 12). SAGE Publications Ltd. https://doi.org/10.1177/2042018820980225
Blough, B., Moreland, A., & Mora, A. (2015). Metformin-Induced Lactic Acidosis with Emphasis on the Anion Gap. Baylor University Medical Center Proceedings, 28(1), 31–33. https://doi.org/10.1080/08998280.2015.11929178
Dhingra, C., Rao, N., Singh, S., Pathak, A. K., Tiwari, V., Kulshrestha, M. R., & Verma, J. (2024). Comparative Analysis of HbA1c Estimation Using Immunoturbidimetry and High-Pressure Liquid Chromatography Methods in Non-Dialysis Chronic Kidney Disease Patients. EJIFCC, 35(3), 195–205. http://www.ncbi.nlm.nih.gov/pubmed/39507575
ElSayed, N. A., McCoy, R. G., Aleppo, G., Bajaj, M., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Gaglia, J. L., Garg, R., Girotra, M., Khunti, K., Lal, R., Lingvay, I., Matfin, G., Neumiller, J. J., Pandya, N., … Bannuru, R. R. (2025). 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025. Diabetes Care, 48(Supplement_1), S181–S206. https://doi.org/10.2337/dc25-S009
Goossens, G. H., Jocken, J. W. E., & Blaak, E. E. (2021). Sexual dimorphism in cardiometabolic health: the role of adipose tissue, muscle and liver. Nature Reviews Endocrinology, 17(1), 47–66. https://doi.org/10.1038/s41574-020-00431-8
Huang, C. Y., & Lee, J. K. (2024). Effects of SGLT2 Inhibitors with and without Metformin in High-Risk, Treatment-Naïve Patients with Diabetes. Journal of Clinical Medicine, 13(5). https://doi.org/10.3390/jcm13051387
Hur, K. Y., Kim, M. K., Ko, S. H., Han, M., Lee, D. W., & Kwon, H. S. (2020). Metformin treatment for patients with diabetes and chronic kidney disease: A Korean diabetes association and Korean society of nephrology consensus statement. In Diabetes and Metabolism Journal (Vol. 44, Issue 1, pp. 3–10). Korean Diabetes Association. https://doi.org/10.4093/dmj.2020.0004
International Diabetes Foundation. (2017). Recommendations For Managing Type 2 Diabetes In Primary Care. www.idf.org/managing-type2-diabetes
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocrine Reviews, 37(3), 278–316. https://doi.org/10.1210/er.2015-1137
Lalau, J. D., Kajbaf, F., Bennis, Y., Hurtel-Lemaire, A. S., Belpaire, F., & De Broe, M. E. (2018). Metformin Treatment in Patients With Type 2 Diabetes and Chronic Kidney Disease Stages 3A, 3B, or 4. Diabetes Care, 41(3), 547–553. https://doi.org/10.2337/dc17-2231
PERKENI. (2024). Buku Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2024. PB PERKENI.
Stumvoll, M., Häring, H.-U., & Matthaei, S. (2008). Metformin. In B. J. Goldstein & D. Müller-Wieland (Eds.), Type 2 Diabetes : Principles and Practice (2nd ed.). Informa Healthcare.
Tang, M., Berg, A., Rhee, E. P., Allegretti, A. S., Nigwekar, S., Karumanchi, S. A., Lash, J. P., & Kalim, S. (2023). The Impact of Carbamylation and Anemia on HbA1c’s Association With Renal Outcomes in Patients With Diabetes and Chronic Kidney Disease. Diabetes Care, 46(1), 130–137. https://doi.org/10.2337/dc22-1399
Vaishali, K., Acharya, C., Kamath, S. U., Amin, R., & Nagri, S. K. (2025). Relationship Between Glycemic Indices and eGFR Values Among Type 2 Diabetes Mellitus Individuals With Chronic Kidney Disease Across Various Progression Stages. Clinical Medicine Insights: Endocrinology and Diabetes, 18. https://doi.org/10.1177/11795514251362516
Zanchi, A., Lehmann, R., & Philippe, J. (2012). Antidiabetic drugs and kidney disease: Recommendations of the Swiss Society for Endocrinology and Diabetology. In Swiss Medical Weekly (Vol. 142). SMW supporting association. https://doi.org/10.4414/smw.2012.13629
