Screening for nephropathy and antiangiotensin use among diabetic patients in an academic community medical center.

Title

Screening for nephropathy and antiangiotensin use among diabetic patients in an academic community medical center.

Creator

Frazee Lawrence A; Samandari Seyhoon; Tanphaichitr Natthavat; Bourguet Claire C; Pfister Eugene W

Publisher

American Journal of Therapeutics

Date

2006
2006-02

Description

The American Diabetes Association recommends routine screening for albuminuria to detect early nephropathy in all patients with diabetes mellitus. If nephropathy is identified, treatment with an antiangiotensin agent decreases progression and improves renal outcomes. Concordance with guidelines for nephropathy screening and antiangiotensin therapy among diabetic patients in a primary care setting of an academic community medical center was evaluated. Medical charts of adult patients with diabetes mellitus from February 2000 through January 2003 were retrospectively reviewed. In part 1 of the study, whether patients were screened for nephropathy at least once was recorded. In part 2 of the study, antiangiotensin prescribing was assessed in all patients and in subgroups stratified by screening. In both parts of the study, patient characteristics and comorbidities were assessed using multivariate analysis to determine their impact on the odds that a patient was screened and that antiangiotensin therapy was prescribed. Among the 329 patients included, 182 patients (55.3%) were screened for nephropathy. Patients who were screened were younger (OR=0.83 for 10-year increase, 95% CI: 0.69-0.99), less likely to have congestive heart failure (OR=0.42, 95% CI: 0.20-0.90), and more likely to be cared for by a resident physician directly supervised by an attending physician (OR=3.03; 95% CI: 1.82-5.03). A total of 215 patients (65.3%) were prescribed antiangiotensin therapy. Hypertension was a predictor of antiangiotensin therapy among all patients who were screened (OR=10.34, 95% CI: 4.45-24.01), those who were screened and negative (OR=15.46, 95% CI: 5.56-42.98), and those who were not screened (OR=10.79, 95% CI: 4.39-26.52). Among patients screened for nephropathy, coronary artery disease (OR=3.01, 95% CI: 1.05-8.63), and the presence of proteinuria (OR=4.26, 95% CI: 1.61-11.24) were predictors of antiangiotensin use. This study found that the likelihood of screening for nephropathy among diabetic patients was inversely associated with a diagnosis of congestive heart failure and increasing age. Conversely, care by a resident physician directly supervised by an attending physician increased the odds that patients would be screened. A diagnosis of hypertension and the presence of albuminuria were each associated with increased use of an antiangiotensin agent.

Subject

*Guideline Adherence; Academic Medical Centers; Age Factors; Aged; Angiotensin II Type 1 Receptor Blockers/*administration & dosage/therapeutic use; Angiotensin-Converting Enzyme Inhibitors/*administration & dosage/therapeutic use; Coronary Artery Disease/diagnosis; Diabetes Mellitus; Diabetic Nephropathies/*diagnosis/epidemiology/etiology; Drug Utilization; Female; Humans; Hypertension/diagnosis/drug therapy; Male; Middle Aged; Practice Guidelines as Topic; Proteinuria/diagnosis; Retrospective Studies; Type 1/complications/drug therapy; Type 2/complications/drug therapy

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

18–23

Issue

1

Volume

13

Citation

Frazee Lawrence A; Samandari Seyhoon; Tanphaichitr Natthavat; Bourguet Claire C; Pfister Eugene W, “Screening for nephropathy and antiangiotensin use among diabetic patients in an academic community medical center.,” NEOMED Bibliography Database, accessed September 23, 2021, https://neomed.omeka.net/items/show/4299.

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