Prioritization of patient-related factors according to renal function in antidiabetic drug selection: The REDIM Project

Abstract

AimsFew studies have evaluated how physicians prioritize renal function among other patient-related factors when stepping-up in antidiabetic treatment. MethodsThe REDIM Spanish national online survey included 550 internists. We firstly tested proficiency in chronic kidney disease (Agrawal's Questionnaire) and motivation in diabetes (DAS-3p Questionnaire). We then analyzed how physicians prioritized renal function, age, weight, glycemic control, non-renal co-morbidities and patient perceptions in five varying fictitious clinical scenarios (generic; ambulatory vs. high cardiovascular risk hospitalized patient, for estimated glomerular filtration rates (eGFRs)=50 vs. 25ml/min/1.73m2). We assigned every item a score (from 5 to 0, highest to lowest relevance) per-physician and compared mean values between clinical scenarios using the t-test for independent means (nominal significance at p<0.05). ResultsCompletion rate was 57.5% (N=316; mean age, 46.3 years; men, 71%). Average scores were 22.6±3.9 (possible range [0–30]) for Agrawal's Questionnaire and 4.1±0.6 (range [1–5]) for DAS-3p Questionnaire. In the generic scenario, renal function had the highest priority (mean=3.36±1.66, range [0–5]). When eGFR was set at 50ml/min/1.73m2, physicians prioritized glycemic control for ambulatory (mean=3.23±1.59) and non-renal co-morbidities for hospitalized patients (mean=3.20±1.68) over renal function (mean=3.18±1.77 for ambulatory, p=0.032; mean=3.11±1.65 for hospitalized patients, p=0.002). When eGFR was subsequently lowered to 25ml/min/1.73m2, renal function again led priorities (mean values=3.73±2.05 for ambulatory and 3.75±1.96 for hospitalized patients; both p<0.001). ConclusionsKnowledge of the degree of renal function impairment induced physicians to prioritize patient-related factors differently when adding a second antidiabetic drug. Renal function led priorities when severely impaired.