Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis

Fig. 1. Patient population

Fig. 2. Proportion of patients undergoing guideline-recommended GFR/UACR assessments. Legend: It is recommended that patients with diabetes are screened annually for kidney disease by assessment of eGFR and urinary albumin:creatinine ratio [3]. Values are percent with 95 % CIs; values are from the last treatment year.

Fig. 3. Proportion of patients achieving HbA1c targets as per guideline recommendation. Legend: Tight glucose control, targeting HbA1c < 7.0 % (or < 53 mmol/mol), is recommended to decrease microvascular complications in patients with diabetes [3]. Values are percent with 95 % CIs.

Fig. 4. Proportion of patients using SGLT-2 as per guideline recommendation. Legend: Treatment with an SGLT2 inhibitor (empagliflozin, canagliflozin or dapagliflozin) is associated with a lower risk of renal endpoints and is recommended* if eGFR is 30 to < 90 mL/min/1.73 m2) [3]. Analyses restricted to the last treatment year; values are percent with 95 % CIs; *Although evidence is very limited for patients with T1DM

Fig. 5. Proportion of patients using GLP-1 RAs as per guideline recommendation. Legend: Treatment with the GLP1-RAs liraglutide and semaglutide is associated with a lower risk of renal endpoints, and should be considered* for DM treatment if eGFR is > 30 mL/min/1.73 m2 [3]. Analyses restricted to the last treatment year; values are percent with 95 % CIs; *Although evidence is not available for patients with T1DM

Fig. 6. Prevalence of treated and controlled hypertension. Legend: It is recommended that patients with hypertension (> 130 mmHg systolic and/or antihypertensive drug use) and diabetes are treated in an individualised manner, SBP to 130 mmHg and < 130 mmHg if tolerated, but not < 120 mmHg. In older people (aged > 65 years) with hypertension (> 140 mmHg systolic and/or antihypertensive treatment) the SBP goal is to a range of 130–139 mmHg [3]. Values are percent with 95 % CIs

Fig. 7. Proportion of patients using ACEi/ARBs as per guideline recommendation. Legend: A RAAS blocker (ACEi or ARB) is recommended for the treatment of hypertension in patients with diabetes, particularly in the presence of microalbuminuria, proteinuria (macroalbuminuria*), or LVH** [3]. Values are percent with 95 % CIs; *Proteinuria was replaced by macroalbuminuria as this was generally determined; **LVH is not available in the DIVE/DPV dataset