Abstract
Purpose: The purpose of this study is to identify whether Internal Medicine house-staff (IMHS)
have awareness and knowledge about the correct dosage of antidiabetic medications
for patients with chronic kidney disease (CKD), as dosing errors result in adverse
patient outcomes for those with diabetes mellitus (DM) and CKD. Methods: There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication
dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular
filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone,
and Sitagliptin. Results: Lack of awareness and knowledge was high, with the highest for Pioglitazone at 72.8%.
For ILA, the percentages were: Pioglitazone: 72.8%, Glipizide: 43.9%, and Sitagliptin:
42.8%. For ILK-GFR, the percentages were: Pioglitazone: 72.8%, Glipizide: 68.3%, and
Sitagliptin: 65.4%. Conclusions: IMHS have poor awareness and knowledge for antidiabetic medication dose adjustment
in patients with DM and CKD. Both Electronic Medical Rerecord best practice advisory
and physician–pharmacist collaborative drug therapy management can enhance safe drug
prescribing in patients with CKD. In addition, IMHS’s practice for antidiabetic medication
dose adjustment was better with Nephrology exposure. A formal didactic educational
training during medical school and residency for antidiabetic medication dose adjustment
in patients with DM and CKD is highly encouraged to prevent medication dosing errors
and to more effectively and safely allow IMHS to manage complex treatment regimens.
Keywords
Adult-onset diabetes mellitus - chronic kidney insufficiency - internal medicine -
medication error - residency and internship
