Clinical Practice Gap Analysis of CKD in T2D From Identification to Diagnosis to Management

Abstract

Understanding clinical practice gaps in the identification, diagnosis and management of CKD in patients with T2D can inform development of tools to improve physician practices. A survey instrument of 25 multiple choice, knowledge- and case-based questions allowed participants to assess their knowledge, attitudes, and confidence with regard to CKD in T2D. The CME-certified activity was available online to physicians across the globe without monetary compensation or charge. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Initial data collection occurred from February 26, 2020, to April 20, 2020. 241 diabetologists/endocrinologists completed the full assessment. Physicians demonstrated gaps in the following areas: Assessment to diagnose kidney disease stage: 47% gap Evidence-based strategies to delay progression of CKD in patients with diabetes: 72% gap SGLT2 inhibitors CVOT data comparisons: 73% gap Results from CREDENCE trial: 43% gap Mechanism of cardiorenal syndrome: 95% gap Link between diabetes, kidney disease, and the cardiorenal syndrome: 42% gap Fibrosis as a component of progression of CKD: 61% gap Knowledge of billing procedure for CKD screening: 64% gap Comparison of safety profiles for approved MRAs: 45% gap Differences in emerging MRAs compared to traditional MRAs: 53% gap Clinical trial data for emerging MRA: 32% gap When asked about satisfaction with current treatment approaches for managing CKD in patients with T2D, 9% selected very satisfied, 75% selected moderately-mostly satisfied, and 17% slightly-not satisfied. This educational research on assessment of physicians’ clinical practices yielded important insights into clinical gaps related to identification, screening, diagnosis, and management of CKD in patients with T2D. Further studies are planned to assess the effect of medical education on decreasing these clinical practice gaps.