Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Patient-centred factors associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease. (#64)

Clement Lo 1 , Edward Zimbudzi 1 , Helena J Teede 1 , Peter Kerr 1 , Sanjeeva Ranasinha 2 , Alan Cass 3 , Gregory Fulcher 4 , Martin Gallagher 5 6 , Kevan Polkinghorne 1 , Grant Russell 7 , Timothy Usherwood 6 8 , Rowan Walker 9 , Sophia Zoungas 1 6
  1. Monash University and Monash Health, Clayton, VIC, Australia
  2. Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
  3. Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
  4. Department of Diabetes and Endocrinology, The Royal North Shore Hospital, Sydney, New South Wales, Australia
  5. Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
  6. The George Institute of Global Health, Sydney, New South Wales, Australia
  7. School of Primary Health Care, Monash University, Melbourne, Victoria, Australia
  8. Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  9. Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia

Background and aims: The extent to which patient-centred factors affect treatment target attainment in co-morbid diabetes and chronic kidney disease (CKD) is unclear. Here, we explore the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets.

Materials and methods: This cross-sectional multi-centre study recruited adults with diabetes and CKD (eGFR between 20 and 60 ml/min/1.73m2). All completed a questionnaire exploring patient-reported barriers to care (elicited from focus groups), the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), the Summary of Diabetes Self-Care Activity (SDSCA) surveys, and had demographic and clinical data collected. Poor glycaemic and BP control were defined as an HbA1c ≥ 8% and systolic BP ≥ 140 mmHg respectively. Multivariable logistic regression was used to identify the most parsimonious models inclusive of age, gender and diabetes duration for poor control, using STATA v13.1.

Results: 199 patients, mean age 68.7 (SD 9.6) were studied. Most were male (70.4%) and had type 2 diabetes (90.0%). There were no differences in the proportion of patients with poor glycaemic and BP control across age groups, gender, smoking status, eGFR, diabetes duration and activation levels. Poor glycaemic control was associated with an increased odds of “poor family support” (OR 4.90; 95% CI 1.80 to 13.32, p ≤ 0.002). Poor BP control was associated with an increased odds of “not having a good GP” (OR 6.01; 2.42 to 14.95, p < 0.001). Poor glycaemic or BP control was not associated with lower PAM, SDSCA and SF-12 scores (all p > 0.05).

Conclusions: Lack of patient perceived family and GP support were associated with increased odds of poor glycemic and blood pressure control. Models of care addressing these issues may improve patient outcomes in co-morbid diabetes and CKD.