Susanne Eder1, Johannes Leierer1, Julia Kerschbaum1, Laszlo Rosivall2, Andrzej Wiecek3, Dick de Zeeuw4, Patrick B Mark5, Georg Heinze6, Peter Rossing7, Hiddo L Heerspink4, Gert Mayer1. 1. 1 Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria. 2. 2 International Nephrology Research and Training Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary. 3. 3 Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland. 4. 4 Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 5. 5 Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK. 6. 6 Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. 7. 7 Steno Diabetes Center Copenhagen and Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolism Center, University of Copenhagen, Copenhagen, Denmark.
Abstract
BACKGROUND: The number of patients with type 2 diabetes mellitus and diabetes mellitus-associated chronic kidney disease varies considerably between countries. Next to differences in genetic as well as life style risk factors, varying practices in medical care delivery might cause this diversity. METHOD: The PROVALID study recruited 4000 patients with type 2 diabetes mellitus at the primary level of healthcare in five European countries (Austria, Hungary, The Netherlands, Poland and Scotland). Baseline data were used to describe patient characteristics and compare the adherence to ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) guidelines with respect to metabolic and blood pressure control, use of renin-angiotensin system-blocking agents, statins and acetylsalicylic acid between the countries. RESULTS: About 34.8% of the population had evidence of diabetes mellitus-associated chronic kidney disease. The median HbA1c level of the cohort was 6.8% (ranging from 6.5 in Poland to 7.0% in Scotland). Mean blood pressure was 136/79 (±17/10) and significantly higher in subjects with elevated albuminuria. These individuals also were more often treated with renin-angiotensin system-blocking agents (74.1% vs 84.6%), whereas the use of statins was driven by cardiovascular comorbidity. Acetylsalicylic acid was used in only 28.9% subjects. Despite similar cardiovascular comorbidities and renal function, the use of renin-angiotensin system-blocking agents varied significantly between the countries from 66.7% to 87.4%. An even higher variability was observed for patients >40 years of age using statins (39.8%-82.7%) and administration of acetylsalicylic acid in patients older than 50 years (5.2%-43.8%). CONCLUSION: Our study shows that medical practice in type 2 diabetes mellitus patients with and without renal disease is different in European countries. Longitudinal follow-up will reveal if this diversity affects clinical endpoints.
BACKGROUND: The number of patients with type 2 diabetes mellitus and diabetes mellitus-associated chronic kidney disease varies considerably between countries. Next to differences in genetic as well as life style risk factors, varying practices in medical care delivery might cause this diversity. METHOD: The PROVALID study recruited 4000 patients with type 2 diabetes mellitus at the primary level of healthcare in five European countries (Austria, Hungary, The Netherlands, Poland and Scotland). Baseline data were used to describe patient characteristics and compare the adherence to ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) guidelines with respect to metabolic and blood pressure control, use of renin-angiotensin system-blocking agents, statins and acetylsalicylic acid between the countries. RESULTS: About 34.8% of the population had evidence of diabetes mellitus-associated chronic kidney disease. The median HbA1c level of the cohort was 6.8% (ranging from 6.5 in Poland to 7.0% in Scotland). Mean blood pressure was 136/79 (±17/10) and significantly higher in subjects with elevated albuminuria. These individuals also were more often treated with renin-angiotensin system-blocking agents (74.1% vs 84.6%), whereas the use of statins was driven by cardiovascular comorbidity. Acetylsalicylic acid was used in only 28.9% subjects. Despite similar cardiovascular comorbidities and renal function, the use of renin-angiotensin system-blocking agents varied significantly between the countries from 66.7% to 87.4%. An even higher variability was observed for patients >40 years of age using statins (39.8%-82.7%) and administration of acetylsalicylic acid in patients older than 50 years (5.2%-43.8%). CONCLUSION: Our study shows that medical practice in type 2 diabetes mellituspatients with and without renal disease is different in European countries. Longitudinal follow-up will reveal if this diversity affects clinical endpoints.
Authors: Hanna Sandelowsky; Björn Ställberg; Fredrik Wiklund; Gunilla Telg; Sofie de Fine Licht; Christer Janson Journal: J Asthma Allergy Date: 2022-04-13
Authors: Kenneth Scott Brimble; Philip Boll; Allan K Grill; Amber Molnar; Danielle M Nash; Amit Garg; Ayub Akbari; Peter G Blake; David Perkins Journal: BMJ Open Date: 2020-02-16 Impact factor: 2.692