Inequalities in the Management of Diabetic Kidney Disease in UK Primary Care: :A Cross‐Sectional Analysis of A Large Primary Care Database

Abstract

Aims: To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. Methods: A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data 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, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin–angiotensin–aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98–0.99), ACR: aRR 0.94 (0.92–0.96), BP: aRR 0.98 (0.97–0.99), HbA 1c: aRR 0.99 (0.98–0.99) and serum cholesterol: aRR 0.97 (0.96–0.98) measured; achieve BP: aRR 0.95 (0.94–0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84–0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90–0.94) or statins: aRR 0.94 (0.92–0.95). 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: aRR 0.91 (0.8–0.95) or HbA 1c: aRR 0.88 (0.85–0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87–0.95). Compared to people of white ethnicity; those 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.

Publication DOI: https://doi.org/10.1111/dme.15153
Divisions: College of Health & Life Sciences > School of Biosciences
College of Health & Life Sciences
College of Health & Life Sciences > Chronic and Communicable Conditions
Additional Information: Copyright © 2023, The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UKThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Uncontrolled Keywords: DKD,diabetes,ethnicity,inequality,Endocrinology,Internal Medicine,Endocrinology, Diabetes and Metabolism
Publication ISSN: 1464-5491
Last Modified: 20 May 2024 07:43
Date Deposited: 30 Jun 2023 16:53
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Related URLs: https://onlinel ... .1111/dme.15153 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2024-01
Published Online Date: 2023-05-24
Accepted Date: 2023-05-21
Authors: Phillips, Katherine
Hazlehurst, Jonathan M.
Sheppard, Christelle
Bellary, Srikanth (ORCID Profile 0000-0002-5924-5278)
Hanif, Wasim
Karamat, Muhammad Ali
Crowe, Francesca L.
Stone, Anna
Thomas, G. Neil
Peracha, Javeria
Fenton, Anthony
Sainsbury, Christopher
Nirantharakumar, Krishnarajah
Dasgupta, Indranil

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