Abstract
OBJECTIVE: To determine differences in the management of Diabetic Kidney Disease (DKD) relevant to patient sex, ethnicity and socioeconomic group in UK primary care.
RESEARCH DESIGN AND METHODS: A cross-sectional analysis as of 1 st January 2019 was undertaken using IQVIA Medical Research Data (IMRD) dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity, and social deprivation.
RESULTS: Of the 2.3 million participants in the database, 161,278 had type 1 or 2 diabetes of whom 32,905 had DKD. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), albumin creatine ratio (ACR): aRR 0.94 (0.92-0.96), blood pressure (BP): aRR 0.98 (0.97-0.99), glycosylated haemoglobin (HbA1c): aRR 0.99 (0.98-0.99), and serum total cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP (<140/80 mmHg): aRR 0.95 (0.94-0.98) or total cholesterol (< 5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed renin-angiotensin-aldosterone system (RAAS) inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95) in the previous year. Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP (<140/80 mmHg): aRR 0.91 (0.8-0.95) or HbA1c (< 58 mmol/mol): aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95), but were 8% more likely to be prescribed a statin: aRR 1.08 (1.06-1.11). Compared to patients of white ethnicity; patients of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97).
CONCLUSIONS: 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.
| Original language | English |
|---|---|
| Article number | e15153 |
| Journal | Diabetic Medicine |
| Early online date | 24 May 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 24 May 2023 |
Bibliographical note
© 2023 Diabetes UK.Keywords
- DKD
- inequality
- diabetes
- ethnicity
Access to Document
- PhillipsK2023Inequalities
This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.