{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:17:04Z","timestamp":1790115424353,"version":"4.0.1"},"reference-count":60,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea Institute of Drug Safety and Risk Management","award":["20221136U0054101S000100"],"award-info":[{"award-number":["20221136U0054101S000100"]}]},{"name":"Korea Institute of Drug Safety and Risk Management","award":["20222396"],"award-info":[{"award-number":["20222396"]}]},{"name":"Korea Institute of Drug Safety and Risk Management","award":["21153MFDS601-1"],"award-info":[{"award-number":["21153MFDS601-1"]}]},{"name":"Korea Institute of Drug Safety and Risk Management","award":["RS-2024-00331810"],"award-info":[{"award-number":["RS-2024-00331810"]}]},{"name":"Kyung Hee University","award":["20221136U0054101S000100"],"award-info":[{"award-number":["20221136U0054101S000100"]}]},{"name":"Kyung Hee University","award":["20222396"],"award-info":[{"award-number":["20222396"]}]},{"name":"Kyung Hee University","award":["21153MFDS601-1"],"award-info":[{"award-number":["21153MFDS601-1"]}]},{"name":"Kyung Hee University","award":["RS-2024-00331810"],"award-info":[{"award-number":["RS-2024-00331810"]}]},{"name":"Ministry of Food and Drug Safety","award":["20221136U0054101S000100"],"award-info":[{"award-number":["20221136U0054101S000100"]}]},{"name":"Ministry of Food and Drug Safety","award":["20222396"],"award-info":[{"award-number":["20222396"]}]},{"name":"Ministry of Food and Drug Safety","award":["21153MFDS601-1"],"award-info":[{"award-number":["21153MFDS601-1"]}]},{"name":"Ministry of Food and Drug Safety","award":["RS-2024-00331810"],"award-info":[{"award-number":["RS-2024-00331810"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background\/Objectives: This study aimed to investigate trends in antidiabetic drug use and assess the risk of metformin-associated lactic acidosis (MALA) in patients with chronic kidney disease (CKD). Methods: A retrospective observational analysis based on the common data model was conducted using electronic medical records from 2010 to 2021. The patients included were aged \u226518, diagnosed with CKD and type 2 diabetes, and had received antidiabetic medications for \u226530 days. MALA was defined as pH \u2264 7.35 and arterial lactate \u22654 mmol\/L. Results: A total of 8318 patients were included, with 6185 in CKD stages 1\u20132 and 2133 in stages 3a\u20135. Metformin monotherapy was the most prescribed regimen, except in stage 5 CKD. As CKD progressed, metformin use significantly declined; insulin and meglitinides were most frequently prescribed in end-stage renal disease. Over the study period, the use of SGLT2 inhibitors (13.3%) and DPP-4 inhibitors (24.5%) increased significantly, while sulfonylurea use decreased (p &lt; 0.05). Metformin use remained stable in earlier CKD stages but significantly decreased in stage 3b or worse. The incidence rate (IR) of MALA was 1.22 per 1000 patient-years, with a significantly increased IR in stage 4 or worse CKD (p &lt; 0.001). Conclusions: Metformin was the most prescribed antidiabetic drug in CKD patients in Korea with a low risk of MALA. Antidiabetic drug use patterns varied across CKD stages, with a notable decline in metformin use in advanced CKD and a rise in SGLT2 inhibitor prescriptions, underscoring the need for further optimized therapy.<\/jats:p>","DOI":"10.3390\/ph17101369","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T07:47:05Z","timestamp":1728892025000},"page":"1369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Trends in Antidiabetic Drug Use and Safety of Metformin in Diabetic Patients with Varying Degrees of Chronic Kidney Disease from 2010 to 2021 in Korea: Retrospective Cohort Study Using the Common Data Model"],"prefix":"10.3390","volume":"17","author":[{"given":"Sung Hwan","family":"Joo","sequence":"first","affiliation":[{"name":"Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungwon","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8481-4367","authenticated-orcid":false,"given":"Suhyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7087-4914","authenticated-orcid":false,"given":"Seok Jun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taemin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0119-5818","authenticated-orcid":false,"given":"Sang Youl","family":"Rhee","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9403-230X","authenticated-orcid":false,"given":"Jae Myung","family":"Cha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul 05278, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2554-3370","authenticated-orcid":false,"given":"Sandy Jeong","family":"Rhie","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea"},{"name":"Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeon Seok","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3497-5514","authenticated-orcid":false,"given":"Yang Gyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9200-2799","authenticated-orcid":false,"given":"Eun Kyoung","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.2337\/dci22-0027","article-title":"Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"45","author":"Khunti","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"825","DOI":"10.7326\/0003-4819-158-11-201306040-00007","article-title":"Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. 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