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Diabet Med. 2016 Sep;33(9):1230-9. doi: 10.1111/dme.13014. Epub 2015 Dec 6.

Quality of care in patients with diabetic kidney disease in Asia: The Joint Asia Diabetes Evaluation (JADE) Registry.

Author information

  • 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
  • 2Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.
  • 3Department of Endocrinology, Peking University First Hospital, Beijing, China.
  • 4Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
  • 5Peking Union Medical College Hospital, Beijing, China.
  • 6The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, Beijing, China.
  • 7Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
  • 8Qualigenics Diabetes Centre, Hong Kong SAR, China.
  • 9Alice Ho Nethersole Hospital, Hong Kong SAR, China.
  • 10Dr M.K. Mukhopadhyay's Diabetic Clinic, Kolkata.
  • 11ILS Hospital, Salt Lake, India.
  • 12Hallym University College of Medicine, Gangwon-do, Korea.
  • 13The Catholic University of Korea, Seocho-gu, Korea.
  • 14Heart of Jesus Hospital, San Jose City, Philippines.
  • 15Senor Sto. Nino Hospital, Tarlac, Philippines.
  • 16New Bilibid Prison Hospital, Bureau of Corrections, Muntinlupa, Philippines.
  • 17Taichung Veterans General Hospital, Taichung, Taiwan.
  • 18Bach Mai Hospital, Hanoi, Vietnam.
  • 19HCMC University of Pharmaceutical and Medicine, Ho Chi Minh City, Vietnam.
  • 20Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China.

Abstract

AIMS:

Diabetic kidney disease independently predicts cardiovascular disease and premature death. We examined the burden of chronic kidney disease (CKD, defined as an estimated GFR < 60 ml/min/1.73 m(2) ) and quality of care in a cross-sectional survey of adults (age ≥ 18 years) with Type 2 diabetes across Asia.

METHODS:

The Joint Asia Diabetes Evaluation programme is a disease-management programme implemented using an electronic portal that systematically captures clinical characteristics of all patients enrolled. Between July 2007 and December 2012, data on 28 110 consecutively enrolled patients (China: 3415, Hong Kong: 15 196, India: 3714, Korea: 1651, Philippines: 3364, Vietnam: 692, Taiwan: 78) were analysed.

RESULTS:

In this survey, 15.9% of patients had CKD, 25.0% had microalbuminuria and 12.5% had macroalbuminuria. Patients with CKD were less likely to achieve HbA1c < 53 mmol/mol (7.0%) (36.0% vs. 42.3%) and blood pressure < 130/80 mmHg (20.8% vs. 35.3%), and were more likely to have retinopathy (26.2% vs. 8.7%), sensory neuropathy (29.0% vs. 7.7%), cardiovascular disease (26.6% vs. 8.7%) and self-reported hypoglycaemia (18.9% vs. 8.2%). Despite high frequencies of albuminuria (74.8%) and dyslipidaemia (93.0%) among CKD patients, only 49.0% were using renin-angiotensin system inhibitors and 53.6% were on statins. On logistic regression, old age, male gender, tobacco use, long disease duration, high HbA1c , blood pressure and BMI, and low LDL cholesterol were independently associated with CKD (all P < 0.05).

CONCLUSIONS:

The poor control of risk factors, suboptimal use of organ-protective drugs and high frequencies of hypoglycaemia highlight major treatment gaps in patients with diabetic kidney disease in Asia.

PMID:
26511783
DOI:
10.1111/dme.13014
[PubMed - in process]
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