#2426 Diabetes treatment in CKD patients—do we treat according to the guidelines?
Authors: Iaina Nomy Levin , El'nasasra Hatem 
Published: May 2024

Background and Aims

T2DM is a global pandemic, frequently complicated by DKD, that may result in ESRD and cardiovascular complications. Despite advancements in diabetes and cardiovascular risk management, the prevalence of DKD continues to grow.

During the last years SGLT2i and GLP1RAs have demonstrated effectiveness in cardiorenal protection. The 2020 KDIGO guidelines recommend these treatments for cardiorenal protection in DKD patients. No data was published on the rate of implementing these guidelines. Identifying a gap between the guidelines and the actual treatment given to patients allows active intervention to enhance adherence to the guidelines and may improve health outcomes of patients.

The aim of the study was to assess KDIGO guidelines implementation by nephrologists in a nephrology clinic, compared to a multidisciplinary diabetes-CKD clinic. This team includes a nephrologist, diabetologist, diabetes nurse and dietitian. The focus is on lifestyle modification education and advanced treatments for DKD.

Method

This study is a retrospective, descriptive, and quantitative convenience sample at a single medical centre. Study population included adult patients over 18 years, with T2DM and CKD, who were treated at the nephrology and diabetes-CKD clinics between May 2021 and May 2022. Type 1 diabetic patients and patients requiring dialysis were excluded. Demographic, diabetes and CKD related data were collected. Utilization of KDIGO recommended medications was analysed and compared between the two clinics.

Results

587 and 100 patients from nephrology and diabetes-CKD clinics, respectively, were included. Baseline characteristics are described in Table 1.

Recommended anti diabetic and other CKD treatments utilization is described in Table 2.

Implementation of recommended medications, including SGLT2i and GLP1RAs, was significantly higher in the diabetes-CKD clinic, demonstrating a significant disparity in guideline adherence between the two clinics. 

Conclusion

DKD is a common complication of T2DM that may progress to ESRD, and associated with increased cardiovascular risk. The evolving landscape of treatment is reflected in updated guidelines from various professional organizations, including KDIGO. These guidelines position SGLT2i and GLP1RAs as 1st and 2nd line treatments for patients with T2DM and CKD.

Patients treated at the diabetes-CKD clinic were younger, had higher incidence of dyslipidemia and IHD and their diabetes was less controlled compared to the nephrology clinic patients. Despite the guidelines, underuse of recommended antidiabetic medications and other treatments persists in nephrology clinics. However, the multidisciplinary approach of the diabetes-CKD clinic, showed improved adherence to guidelines.

In conclusion, the study provides insights into the challenges of implementing KDIGO guidelines in real world nephrology clinical settings. Further research is warranted to understand factors contributing to the low adherence. The findings suggest that a multidisciplinary approach may enhance guideline compliance and subsequently improve outcomes in managing DKD in T2DM.