Key result
Patients with advanced diabetic nephropathy had similarly low rates of blood pressure control (<130/80 mmHg) across nephrology, diabetology, and primary care settings (14%, 13%, and 10%; P=0.421).
Why the study?
Does the clinical setting (nephrology, diabetology, or primary care) affect the control of cardiovascular risk factors in patients with advanced type 2 diabetic nephropathy?
Cross-Sectional (n=707)
Yes
Does the clinical setting (nephrology, diabetology, or primary care) affect the control of cardiovascular risk factors in patients with advanced type 2 diabetic nephropathy?
p-value: p=0.421
Patients with advanced diabetic nephropathy are frequently under-treated for cardiovascular risk factors, particularly blood pressure, regardless of whether they are managed in nephrology, diabetology, or primary care settings.
Poor BP control persists across specialties in advanced diabetic nephropathy; leaves open whether setting-specific strategies improve outcomes.
OBJECTIVES: Advanced diabetic nephropathy (DN) is characterized by a marked development of cardiovascular and renal disease. These patients are frequently managed by different health professionals with the consequence that the quality of care may differ substantially. To compare the management of cardiovascular risk factors in patients with type 2 DN and an estimated glomerular filtration rate (GFR) of 15-60 ml/min per 1.73 m2 followed in nephrology, diabetology and primary care. METHODS: This multicentre cross-sectional study verified the control of blood pressure (BP), total cholesterol, triglycerides, glycosylated haemoglobin A1c (HbA1c) and haemoglobin in patients exclusively followed in either nephrology (n = 266), diabetology (n = 246) or primary care (n = 195) of the same metropolitan area for at least 1 year. RESULTS: Primary care patients were older and had a greater prevalence of previous cardiovascular events. The GFR was lower in nephrology than in diabetology and primary care (33 +/- 13 versus 47 +/- 9 and 40 +/- 12 ml/min per 1.73 m2, P < 0.0001). The prevalence of BP target (< 130/80 mmHg) was similarly low in nephrology, diabetology and primary care (14, 13 and 10%, P = 0.421) probably because of insufficient prescription of diuretics and low-salt diet. Whereas the prevalence of the triglycerides target was similar, that of total cholesterol (< 200 mg/dl) was larger in diabetology (63%) than in nephrology and primary care (59 and 46%, P = 0.003) because of greater statin prescription in hypercholesterolemic individuals (70, 50 and 41%, respectively, P = 0.002). The attainment of HbA1c less than 7% was less frequent in diabetology (32%) than in nephrology and primary care (61 and 46%, P = 0.0003) despite a more frequent prescription of insulin/oral agents in diabetology. The control of anaemia was better in diabetology. Multivariate analysis adjusted for the patient case-mix and physician-level clustering confirmed these differences except for anaemia. CONCLUSION: Patients with advanced DN, despite the worst renal and cardiovascular prognosis, are at high risk of being under-treated independently of the type of clinical setting.
No takes yet. Share an insight, caveat, or question.
Minutolo et al. (2006) conducted a cross-sectional in Type 2 diabetic nephropathy (n=707). Clinical setting (nephrology, diabetology, primary care) was evaluated on Control of blood pressure (< 130/80 mmHg) (p=0.421). Patients with advanced diabetic nephropathy had similarly low rates of blood pressure control (<130/80 mmHg) across nephrology, diabetology, and primary care settings (14%, 13%, and 10%; P=0.421).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: