Cardiovascular outcome according to renal status in Finnish patients with type 2 diabetes

Chronic kidney disease has been suggested as the main contributor to the increased cardiovascular morbidity and mortality in type 2 diabetes. Diabetic kidney disease is also the leading cause for starting renal replacement therapy. In this study, real-world data was collected from both primary and specialized care, to describe routine monitoring of T2DM patients in clinical practice.

Type 2 diabetes have been associated with albuminuria and decreased estimate GDFR. Poor glycemic control and lowered kidney function increase the risk of cardiovascular morbidity, including atrial fibrillation, among type 2 diabetics. Clinical trials have shown that SGLT2 inhibitors reduce the risk of cardiovascular events in T2DM, which has expanded their use within the type 2 diabetes patient population.

This RWE-study was conducted in collaboration between Mundipharma, Medaffcon, and clinical experts. It aimed to describe the characteristics of Type 2 diabetes patients from a large real-world cohort. In this study, the use of routine diagnostic and monitoring measures in the management of Type 2 Diabetes patients in contemporary clinical practice were mapped, and the proportion of patients that could benefit from SGLT2 inhibitor treatment was assessed.

Type 2 diabetes patients were more often men (54%) with mean age of 64 years. Of the patients with available eGFR data, CKD stage 3-5 was observed in 13%. 67% of patients were described ACE inhibitor or angiotensin receptor blocker.

The study showed data on albuminuria, HbA1c and eGFR, although being a significant part of the standard of care, was missing in a large proportion of the patient cohort. Albuminuria measurements alone were present in less than half of type 2 diabetics patient records, suggesting a suboptimal level of surveillance among the patient population. Patients with available measurements, increased albumin excretion was present in 12% of patients with CKD class 1–2, of whom 1.6% had severe albuminuria.

Atrial fibrillation was independently associated with the risk of cardiovascular events and end-stage kidney disease in type 2 diabetes patients. In this cohort, every tenth patient was diagnosed with atrial fibrillation, and the prevalence increased substantially along with increasing CKD stage, as expected.

Study background

This study utilized patient register data collected from type 2 diabetics in regular clinical practice from both primary care and specialized care. The data was collected from the electronic health records of the hospital district of South-West Finland, Statistic Finland, and the National Institute for Health and Welfare. The cohort consisted of 29 628 patients, who were followed from 2012 until the end of 2018 or until death.