Authors (including presenting author) :
Chen XR Catherine, Chan FL, Chan KL, Li YC
Affiliation :
Dept. of Famliy Medicine and GOPCs, Kowloon Central Cluster
Introduction :
Type 2 diabetes mellitus (T2DM) is one of the most common chronic conditions encountered in primary care. Proteinuria is a well-known predictor of poor renal and cardiovascular outcomes in T2DM patients.
Objectives :
To explore the prevalence of Therapeutic inertia (TI) on proteinuria management among T2DM patients managed in the primary care and to explore possible associating factors in both patients’ and doctors’ perspective.
Methodology :
Study design: Cross-sectional study
Subjects: T2DM patients with microalbuminuria and macroalbuminuria and had been followed up in General Outpatient Clinics (GOPCs) of Kowloon Central Cluster (KCC) from 1 Jan, 2014 to 31 Dec, 2015.
Outcome assessments: The prevalence of TI on proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors.
Statistical analysis: Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics.
Result & Outcome :
Among the 22,644 T2DM patients identified in the case register, 5, 163 (26.4%) patients had diabetic nephropathy (DMN) with micro- or macroalbuminuria. Among the sampled 385 patients with DMN, TI was found to be present in 155 cases, with a prevalence rate of 40.3%. Male Drs, doctors with longer duration of clinical practice and who have never received any form of Family Medicine training were found to have a higher rate of TI. Patients with microalbuminuria and lower average systolic (SBP) and diastolic blood pressure reading were also found to have more TI. Logistic regression study revealed that patients’ SBP reading and microalbuminuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 21 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI.
Conclusions:
TI is commonly present on proteinuria management among T2DM patients managed in the primary care. Patient’s systolic blood pressure reading, microalbuminuria level, Dr’s year of clinical practice and dose of ACEI/ARB were found to be associated with the presence of TI. Further study on the barriers and strategies to combat TI is needed to improve the clinical outcome among T2DM patients.
