Division of General Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
Montefiore Medical Center and Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
J Gen Intern Med. 2023 May;38(7):1599-1605. doi: 10.1007/s11606-022-07863-0. Epub 2022 Nov 9.
Renin and angiotensin system inhibitors (RAASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended for patients with diabetic kidney disease (DKD) to reduce the progression to end-stage kidney disease; however, they are under-prescribed.
To evaluate the frequency of care gaps in RAASi and SGLT2i prescription by patient demographic, health system, and clinical factors in patients with DKD.
Retrospective cohort study.
Adult primary care patients with DKD at an integrated health system in Bronx, NY, with 23 primary care sites in 2021.
The odds of having a care gap for (1) SGLT2i or (2) RAASi prescription. Multivariate logistic regression models were performed for each outcome measure to evaluate associations with patient demographic, health system, and clinical factors.
Of 7199 patients with DKD, 80.3% had a care gap in SGLT2i prescription and 42.0% had a care gap in RAASi prescription. For SGLT2i, patients with A1C at goal (aOR 2.32, 95% CI 1.96-2.73), Black non-Hispanic race/ethnicity (aOR 1.46, 95% CI 1.15-1.87), and Hispanic race/ethnicity (aOR 1.46, 95% CI 1.11-1.92) were more likely to experience a care gap. For RAASi, patients with blood pressure at goal (aOR 1.34, 95% CI 1.21-1.49) were more likely to experience a care gap.
The care gaps for SGLT2i and RAASi for patients with DKD with well-controlled diabetes and blood pressure suggest failure to recognize DKD as an independent indication for these medications. Racial/ethnic disparities for SGLT2i, but not for RAASi, suggest systemic racism exacerbates care gaps for novel medications. These factors can be targets for interventions to improve patient care.
肾素-血管紧张素系统抑制剂（RAASi）和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）被推荐用于患有糖尿病肾病（DKD）的患者，以降低进展为终末期肾病的风险；然而，这些药物的处方率较低。
评估患者的人口统计学、卫生系统和临床因素对 DKD 患者 RAASi 和 SGLT2i 处方的护理差距频率。
回顾性队列研究。
在纽约布朗克斯的一个综合卫生系统的成年初级保健患者，2021 年有 23 个初级保健站点患有 DKD。
（1）SGLT2i 或（2）RAASi 处方护理差距的可能性。为每个结果测量值执行多变量逻辑回归模型，以评估与患者人口统计学、卫生系统和临床因素的关联。
在 7199 名患有 DKD 的患者中，80.3%的患者 SGLT2i 处方存在护理差距，42.0%的患者 RAASi 处方存在护理差距。对于 SGLT2i，A1C 达标患者（aOR 2.32，95%CI 1.96-2.73）、非裔美国人（aOR 1.46，95%CI 1.15-1.87）和西班牙裔（aOR 1.46，95%CI 1.11-1.92）更有可能出现护理差距。对于 RAASi，血压达标患者（aOR 1.34，95%CI 1.21-1.49）更有可能出现护理差距。
对于糖尿病和血压控制良好的 DKD 患者，SGLT2i 和 RAASi 的护理差距表明未能将 DKD 视为这些药物的独立适应证。SGLT2i 而非 RAASi 的种族/民族差异表明，系统性种族主义加剧了新型药物的护理差距。这些因素可以成为改善患者护理的干预措施的目标。
