scholarly journals Comment on Stempniewicz et al. Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations. Diabetes Care 2021;44:2000–2009

Diabetes Care ◽  
2021 ◽  
Vol 45 (1) ◽  
pp. e19-e20
Author(s):  
Jonah Mink ◽  
Raj Thakkar ◽  
Danielle Jeddah
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetes Care ◽  
Health Care Organizations ◽  
Primary Care Patients ◽  
Disease Testing

scholarly journals Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

Diabetes Care ◽  
2021 ◽  
pp. dc202715
Author(s):  
Nikita Stempniewicz ◽  
Joseph A. Vassalotti ◽  
John K. Cuddeback ◽  
Elizabeth Ciemins ◽  
Amy Storfer-Isser ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Care Organizations ◽  
Primary Care Patients ◽  
Disease Testing

scholarly journals Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

2021 ◽  
Author(s):  
Nikita Stempniewicz ◽  
Joseph A. Vassalotti ◽  
John K. Cuddeback ◽  
Elizabeth Ciemins ◽  
Amy Storfer-Isser ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Health Care Organizations ◽  
The United States ◽  
Testing Rate

<b>Objective: </b>Clinical guidelines for people with diabetes recommend chronic kidney disease (CKD) testing at least annually using estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the United States. <p><b>Research Design and Methods:</b> Electronic health record data were analyzed from 513,165 adults with type 2 diabetes, receiving primary care from 24 health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both ≥1 eGFR and ≥1 uACR, <a></a><a>and each test</a> individually, in the 1, 2, and 3 years ending September 2019, by health care organization and clinical practice site. Elevated albuminuria was defined by uACR ≥30 mg/g.</p> <p><strong>Results:</strong> The 1-year median testing rate across organizations was 51.6% for both uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10<sup>th</sup>–90<sup>th</sup> percentile) from 44.7% to 63.3% across organizations and from 13.3% to 75.4% across sites. Over 3 years, the median testing rate for uACR across organizations was 73.7%. Overall, the prevalence of detected elevated albuminuria was 15%. The average prevalence of detected elevated albuminuria increased linearly with uACR testing rates at sites, with estimated prevalence of 6%, 15%, and 30%, at uACR testing rates of 20%, 50%, and 100%. </p> <p><strong>Conclusions:</strong> While eGFR testing rates are uniformly high among people with type 2 diabetes, testing rates for uACR are suboptimal and highly variable across and within the organizations examined. Guideline-recommended uACR testing should increase detection of CKD.</p>

scholarly journals Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

2021 ◽  
Author(s):  
Nikita Stempniewicz ◽  
Joseph A. Vassalotti ◽  
John K. Cuddeback ◽  
Elizabeth Ciemins ◽  
Amy Storfer-Isser ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Health Care Organizations ◽  
The United States ◽  
Testing Rate

<b>Objective: </b>Clinical guidelines for people with diabetes recommend chronic kidney disease (CKD) testing at least annually using estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the United States. <p><b>Research Design and Methods:</b> Electronic health record data were analyzed from 513,165 adults with type 2 diabetes, receiving primary care from 24 health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both ≥1 eGFR and ≥1 uACR, <a></a><a>and each test</a> individually, in the 1, 2, and 3 years ending September 2019, by health care organization and clinical practice site. Elevated albuminuria was defined by uACR ≥30 mg/g.</p> <p><strong>Results:</strong> The 1-year median testing rate across organizations was 51.6% for both uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10<sup>th</sup>–90<sup>th</sup> percentile) from 44.7% to 63.3% across organizations and from 13.3% to 75.4% across sites. Over 3 years, the median testing rate for uACR across organizations was 73.7%. Overall, the prevalence of detected elevated albuminuria was 15%. The average prevalence of detected elevated albuminuria increased linearly with uACR testing rates at sites, with estimated prevalence of 6%, 15%, and 30%, at uACR testing rates of 20%, 50%, and 100%. </p> <p><strong>Conclusions:</strong> While eGFR testing rates are uniformly high among people with type 2 diabetes, testing rates for uACR are suboptimal and highly variable across and within the organizations examined. Guideline-recommended uACR testing should increase detection of CKD.</p>

Time to develop chronic kidney disease in an Ecuadorian Type 2 Diabetes Mellitus cohort: Survival analysis in primary care

2021 ◽  
pp. 108108
Author(s):  
Carrasco-Tenezaca Felipe ◽  
Barrera-Guarderas Francisco ◽  
De la Torre-Cisneros Katherine ◽  
Medina-Escudero Miguel ◽  
Venegas-Baca Oscar
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Survival Analysis ◽  
Kidney Disease

scholarly journals Declining trends of diabetic nephropathy, retinopathy and neuropathy with improving diabetes care indicators in Japanese patients with type 2 and type 1 diabetes (JDDM 46)

2018 ◽  
Vol 6 (1) ◽  
pp. e000521 ◽  
Author(s):  
Hiroki Yokoyama ◽  
Shin-ichi Araki ◽  
Koichi Kawai ◽  
Katsuya Yamazaki ◽  
Osamu Tomonaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Diabetes Care ◽  
Microvascular Complications ◽  
Treatment Target ◽  
Younger Patients

ObjectiveWe examined changes in prevalence of diabetic microvascular/macrovascular complications and diabetes care indicators for adults in Japan with type 2 and type 1 diabetes over one decade.Research design and methodsTwo independent cohorts were recruited with the same inclusion criteria in 2004 (cohort 1: 3319 with type 2 and 286 with type 1 diabetes) and in 2014 (cohort 2: 3932 with type 2 and 308 with type 1 diabetes). Prevalence of complications and care indicators including achieving treatment targets for glycemia, blood pressure, lipid control, body mass index (BMI), and smoking were compared. In addition, patients in cohort 1 were re-examined in 2014 and their data were compared with the baseline data of each cohort.ResultsIn type 2 diabetes, the prevalence of nephropathy, retinopathy, neuropathy, chronic kidney disease, current smoking and stroke significantly decreased, with improvements in achieving treatment target rates in cohort 2 two as compared with cohort 1. In type 1 diabetes, the prevalence of nephropathy, retinopathy, chronic kidney disease, and hemoglobin A1Cvalues significantly decreased. Decreases in prevalence of microvascular complications in type 2 diabetes were similarly found in each age-matched and sex-matched group, whereas younger patients exhibited marked increase in BMI and lower treatment target achieving rates compared with elderly patients. Regarding normoalbuminuric renal impairment, only a slight increase in the prevalence was observed both in type 2 and type 1 diabetes. In cohort 1, re-examined in 2014, care indicators were significantly improved from 2004, while complications increased with getting 10 years older.ConclusionsWe observed declining trends of diabetic microvascular complications with improvement in diabetes care indicators in type 2 and type 1 diabetes. Younger patients with type 2 diabetes exhibited marked increase in BMI and lower rates of achieving treatment targets compared with elderly patients, which remains a concern.

HbA1c is a reliable test for type 2 diabetes in primary care irrespective of chronic kidney disease

BMJ ◽  
2014 ◽  
Vol 348 (jun18 5) ◽  
pp. g3780-g3780 ◽  
Author(s):  
K. E. Shipman ◽  
M. Jawad ◽  
K. M. Sullivan ◽  
C. Ford ◽  
R. Gama
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Reliable Test

scholarly journals Primary Care Detection of Chronic Kidney Disease in Adults with Type-2 Diabetes: The ADD-CKD Study (Awareness, Detection and Drug Therapy in Type 2 Diabetes and Chronic Kidney Disease)

PLoS ONE ◽  
2014 ◽  
Vol 9 (11) ◽  
pp. e110535 ◽  
Author(s):  
Lynda A. Szczech ◽  
Rebecca C. Stewart ◽  
Hsu-Lin Su ◽  
Richard J. DeLoskey ◽  
Brad C. Astor ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease

scholarly journals Prevalence of Atherosclerotic Cardiovascular Disease, Heart Failure, and Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus: A Primary Care Research Network-based Study

2021 ◽  
Author(s):  
Geert Goderis ◽  
Bert Vaes ◽  
Pavlos Mamouris ◽  
Eline van Craeyveld ◽  
Chantal Mathieu
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Research Network ◽  
Blood Pressure Target ◽  
Atherosclerotic Cardiovascular Disease

Abstract Aims This study aims to assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), and their combined presence in type 2 diabetes (T2D) patients in primary care for whom the 2019 ADA/EASD consensus update “Management of Hyperglycemia in Type 2 Diabetes” recommends GLP-1 receptor agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-I) as first-line medications after metformin. Methods Data were obtained in 2015 from Intego, a morbidity registration network of 111 general practitioners (GPs) working in 48 practices and including 123 261 registered patients. Results Of 123 261 patients, 9616 had T2D. Of these patients, 4200 (43.7%) presented with ASCVD and/or CKD and/or HF. Specifically, 3348 (34.8%) patients had ASCVD, 388 (4.0%) had heart failure, and 1402 (14.6%) had CKD. Compared to patients without any of these comorbidities, patients with at least 1 of these conditions were older (69.7 ±12.6 vs. 63.1±12.5 years), had higher LDL-C values (104.2±35.8 mg/dl vs. 97.2±37.7) and less frequently achieved the systolic blood pressure target of 140 mm Hg (53 vs. 61%) (all p<0.001). Comorbid patients also had significantly more other comorbidities, such as dementia or cancer; received more recommended medications, such as statins; and received less metformin. Most patients with HF (325; 3.4%) had ASCVD (114; 1.2%), CKD (76; 0.8%), or both (135; 1.4%). In total, 478 patients with CKD (5.0%) also had ASCVD. Conclusions At the primary care level, 44% of T2D patients suffer from ASCVD, CKD, and/or HF, and thus qualify for GLP-1RA or SGLT2-I therapy.

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