How frequently the clinical practice recommendations for nephropathy are achieved in patients with type 2 diabetes mellitus in a primary health-care setting?

Objective: To determine the proportion of DM2 patients in primary health-care setting who meet clinical practice recommendations for nephropathy.

Material And Methods: 735 patients were included in this cross-sectional study. Nephropathy was defined as glomerular filtration rate < 60 mL/min/1.73 m2 or albuminuria > or = 30 mg/day. To estimate the proportion of patients meeting clinical practice recommendations, the achieved level was classified according to NKF -K/DOQI, ADA, IDF, JNC 7 report, and NCEP-ATPIII.

Results: A high frequency of kidney disease and cardiovascular risk factors (smoking, alcoholism, obesity) was observed. Adequate levels were attained in 13% for fasting glucose, 45% for blood pressure, 71% for albuminuria, and 30% for lipids. Nephropathy was diagnosed in 41%. Adequate systolic blood pressure was observed in 40% of patients with nephropathy vs. 49% without nephropathy (p = 0.03). In both groups, body mass index was acceptable in one fifth of patients, and waist circumference in two thirds of men and one third of women (p = NS). Patients with nephropathy used more antihypertensives, particularly angiotensin converting enzyme inhibitors (nephropathy 49% vs. no nephropathy 38%, p = 0.004). Subjects with nephropathy received more frequently (p = 0.05) insulin (11%) than those without nephropathy (7%). In both groups, there was low use of statins (nephropathy 14% vs. no nephropathy 17%, p = 0.23), and aspirin (nephropathy 7% vs. no nephropathy 5%, p = 0.39).

Conclusions: Recommended goals for adequate control of DM2 patients attending primary health-care units are rarely achieved, and this was independent of the presence of nephropathy. These findings are disturbing, as poor clinical and metabolic control may eventually cause that patients without nephropathy develop renal damage, and those subjects already with renal disease progress to renal insufficiency.