Diabetes Management and Outcomes among Patients with Type 2 Diabetes Attending a Renal Service.

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  • Additional Information
    • Source:
      Publisher: Hindawi Limited Country of Publication: England NLM ID: 101605237 Publication Model: eCollection Cited Medium: Internet ISSN: 2314-6753 (Electronic) NLM ISO Abbreviation: J Diabetes Res Subsets: MEDLINE
    • Publication Information:
      Publication: <2019>-: London, United Kingdom : Hindawi Limited
      Original Publication: Nasr City, Cairo : Hindawi Publishing Corporation, [2013]-
    • Subject Terms:
      Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/epidemiology ; Hypoglycemia*/chemically induced ; Retinal Diseases*/chemically induced; Humans ; Adolescent ; Adult ; Hypoglycemic Agents/therapeutic use ; Glycated Hemoglobin ; Retrospective Studies ; Cross-Sectional Studies ; Insulin/therapeutic use
    • Abstract:
      Background: Patients with comorbid type 2 diabetes mellitus (T2DM) and renal disease, particularly those treated with insulin, often require complex pharmacological treatment and management of other diabetes complications.
      Aims: To assess the achievement of metabolic targets and compare the current management of renal service attenders with insulin- and noninsulin-treated T2DM.
      Methods: Single-centre retrospective cross-sectional study involving medical record review of patients with T2DM aged ≥18 years who visited a metropolitan renal outpatient clinic in 2017. Univariable analysis and multivariable logistic regression were used to identify factors associated with insulin treatment.
      Results: Among 268 patients (45.5% insulin-treated), mean HbA1c was higher in insulin-treated vs. noninsulin-treated patients (8.0 ± 1.8% (64 mmol/mol) vs. 6.8 ± 1.2% (51 mmol/mol), p < 0.001). Significantly fewer insulin-treated patients had HbA1c ≤ 7.0% (53 mmol/mol; 31.8% vs. 69.3%, p < 0.001). More insulin-treated patients had ischaemic heart disease (46.7% vs. 33.6%, p = 0.028), diabetic foot disease (15.6% vs. 4.8%, p = 0.003), retinopathy (40.2% vs. 11.0%, p < 0.001), and emergency attendance for severe hypoglycaemia (3.8% vs. 0% p = 0.042). Insulin treatment was more associated with chronic kidney disease stages 4-5 (adjusted odds ratio (aOR) 2.41, 95% CI 1.07-5.43), retinopathy (aOR 3.10, 95% CI 1.04-9.27), and podiatry review (aOR 5.06, 95% CI 1.20-21.38). Only 38 (14.2%) individuals were seen by a colocated public multidisciplinary diabetes service in 2017.
      Conclusions: Renal clinic attenders with T2DM, particularly if insulin-treated, remained at increased risk of diabetes-related complications, including severe hypoglycaemia, with limited input from the colocated hospital diabetes team. Approaches to increase coordination of diabetes care among renal patients should be investigated.
      Competing Interests: The authors declare that they have no conflicts of interest.
      (Copyright © 2023 Elizabeth Skalkos et al.)
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    • Accession Number:
      0 (Hypoglycemic Agents)
      0 (Glycated Hemoglobin)
      0 (Insulin)
    • Publication Date:
      Date Created: 20230508 Date Completed: 20230509 Latest Revision: 20230509
    • Publication Date:
      20240628
    • Accession Number:
      PMC10156453
    • Accession Number:
      10.1155/2023/1969145
    • Accession Number:
      37152098