Evaluating risk stratification according to Type 2 diabetes guidelines in primary care - Insights from the Danish DIAGRAM project.

Abstract

To evaluate how Danish General Practitioners (GPs) apply Type 2 diabetes guideline recommendations for risk stratification and management across patient subgroups defined by existing chronic kidney disease (CKD), heart failure (HF), cardiovascular disease (CVD), or elevated risk of incident CVD. 131 GPs responded to a questionnaire on guideline usage and reviewed randomised patient electronic medical records (EMRs), noting demographics, treatment, comorbidities, and presence of six prespecified CVD risk factors. Patients without comorbidities but with ≥ 3 risk factors were deemed at Higher CVD Risk. When missing data prevented allocation to risk groups, CVD risk was Undefined. Of 1964 EMRs meeting inclusion criteria, 641 (33 %) had ≥ 1 cardiorenal comorbidity. Of 1307 without comorbidities, 513 (26 %) were at Higher CVD Risk; risk was Undefined for 668 (34 %). Organ-protective antihyperglycaemic agents were used in 1114/1964 (57 %), and more frequently (61-68 %) across comorbidity subgroups, while CVD risk group status did not correlate with guideline-directed organ-protective treatment. Finally, whereas GPs allocated 379 (19 %) patients to CKD, 596 (30 %) EMRs included laboratory data suggesting presence of CKD. Organ-protective treatment patterns suggest that GPs distinguish patients by comorbidity status but find guideline-defined CVD risk challenging to apply. Additionally, CKD may be underdiagnosed in T2D patients.