Inequalities in the management of diabetic kidney disease in UK primary care: A cross‐sectional analysis of a large primary care database
Authors' conclusion
There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.
Study context
- Population
- People with diabetic kidney disease (DKD) (T1D or T2D) in UK primary care, IQVIA Medical Research Data dataset, as of January 1, 2019DKD
- Participants
- 32,905 people
- Exposure
- DKD management by sex, ethnicity and socio-economic group
- Outcome
- Proportion of people with DKD managed in accordance with national guidelines, stratified by demographics
Methodological detailslarge primary care database, robust Poisson regression adjusted for age, sex, ethnicity and social deprivation, Database of 2.3 million participants; 161,278 with T1D or T2D
- Large primary care database
- Robust Poisson regression adjusted for age, sex, ethnicity and social deprivation
- Database of 2.3 million participants; 161,278 with T1D or T2D
Main finding
As reported in the abstract
Management of DKD in accordance with national guidelines
Albumin creatinine ratio (ACR) measured
60%
Achieved blood pressure (BP) target (<140/90 mmHg)
64%
Achieved HbA1c target (<58 mmol/mol)
58%
Prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year
68%
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Management by sex (women vs men)Womenvs Men | aRR, creatinine measured 0.99 (95% CI 0.98–0.99) | |
| Management by sex (women vs men)Womenvs Men | aRR, ACR measured 0.94 (95% CI 0.92–0.96) | |
| Management by sex (women vs men)Womenvs Men | aRR, BP measured 0.98 (95% CI 0.97–0.99) | |
| Management by sex (women vs men)Womenvs Men | aRR, HbA1c measured 0.99 (95% CI 0.98–0.99) | |
| Management by sex (women vs men)Womenvs Men | aRR, serum cholesterol measured 0.97 (95% CI 0.96–0.98) | |
| Management by sex (women vs men)Womenvs Men | aRR, BP target achieved 0.95 (95% CI 0.94–0.98) | |
| Management by sex (women vs men)Womenvs Men | aRR, total cholesterol (<5 mmol/L) target achieved 0.86 (95% CI 0.84–0.87) | |
| Management by sex (women vs men)Womenvs Men | aRR, RAAS inhibitor prescribed 0.92 (95% CI 0.90–0.94) | |
| Management by sex (women vs men)Womenvs Men | aRR, statin prescribed 0.94 (95% CI 0.92–0.95) | |
| Management by deprivation (most vs least deprived areas)Most deprivedvs Least deprived | aRR, BP measured 0.98 (CI 0.96–0.99) | |
| Management by deprivation (most vs least deprived areas)Most deprivedvs Least deprived | aRR, BP target achieved 0.91 (CI 0.8–0.95) | |
| Management by deprivation (most vs least deprived areas)Most deprivedvs Least deprived | aRR, HbA1c target achieved 0.88 (CI 0.85–0.92) | |
| Management by deprivation (most vs least deprived areas)Most deprivedvs Least deprived | aRR, RAAS inhibitor prescribed 0.91 (CI 0.87–0.95) | |
| Management by ethnicity (black vs white) | aRR, statin prescribed 0.91 (CI 0.85–0.97) | |
| 0.512Ratio (log scale) |
Original publication
Inequalities in the management of diabetic kidney disease in UK primary care: A cross‐sectional analysis of a large primary care database. Diabet Med. Published 14 June 2023. doi:10.
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