#3319 Sex related disparities in the management of diabetic kidney disease: a retrospective analysis in a health region

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Abstract Background and Aims The aim of this study is to assess adherence to international guidelines for the screening and management of diabetic kidney disease (DKD) in a health region serving a population of approximately 300,000. Specifically, we aim to evaluate the annual screening rates for albuminuria and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus (T2DM), as well as the use of SGLT2 inhibitors (iSGLT2) in the treatment of DKD, as recommended by the KDIGO guidelines. Method This observational, retrospective study utilized an anonymized database extracted from electronic health records. The study included prevalent patients with T2DM during 2021, excluding those with type 1 diabetes, gestational diabetes, non-residents in the Health Region, patients under 18 years old, and those who died in 2021. A total of 21,199 patients with T2DM were included, comprising 11,584 men (54.6%) and 9,615 women (45.4%). DKD was defined as the presence of T2DM with either an eGFR <60 mL/min/1.73 m² or albuminuria ≥30 mg/g in a spot urine sample or 24-hour urine collection. The study assessed the proportion of patients who underwent annual screening for albuminuria and eGFR, as well as the proportion of patients with DKD who were treated with iSGLT2 inhibitors. Results Of the 21,199 patients with T2DM, 19,480 (91.9%) had at least one plasma creatinine measurement in 2021, but only 12,200 (57.5%) had at least one albuminuria test, indicating suboptimal adherence to the recommended annual screening for DKD. Among the 21,199 patients, 6,175 (29.1%) met the criteria for DKD. Of these, 1,146 had both reduced eGFR and albuminuria, 2,226 had albuminuria with normal eGFR, and 2,503 had reduced eGFR without albuminuria. Among the 6,012 patients with DKD and eGFR ≥20 mL/min/1.73 m², only 1,238 (20.6%) were treated with iSGLT2 inhibitors. The treatment rate was higher in patients with albuminuria (24.9%) compared to those without albuminuria (14.4%); OR 1.96 (95% CI: 1.71–2.24). Further analysis revealed gender disparities in the screening and treatment of DKD. Among the 6,175 patients with DKD, 55.47% were men and 44.3% were women. Men were less likely to have albuminuria testing (63.4%) compared to women (51.9%), with an odds ratio (OR) of 0.62 (95% CI: 0.589–0.658). Additionally, women with DKD were less likely to receive treatment with iSGLT2 inhibitors (14.6%) compared to men (25.4%), with an OR of 0.50 (95% CI: 0.439–0.573). Conclusion The study highlights significant gaps in the screening and management of DKD in patients with T2DM. Despite international guidelines recommending annual screening for albuminuria and eGFR, only 58% of patients underwent both tests. Furthermore, the use of SGLT2 inhibitors, which are recommended as first-line treatment for DKD, was suboptimal, with only 20.6% of eligible patients receiving this therapy (consistent with previous reports). The treatment rates with iSGLT2 inhibitors were particularly low in DKD patients without albuminuria, especially in women, indicating potential gender disparities in the management of DKD that cannot be justified by fear of urinary tract infections. These findings underscore the need for improved adherence to clinical guidelines, particularly in early detection and treatment of DKD. Enhanced screening protocols and greater awareness of the benefits of iSGLT2 inhibitors, especially in women, could lead to better outcomes for patients with DKD.

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