Status of screening and preventive efforts against diabetic kidney disease between 2013 and 2018: analysis using an administrative database from Kyoto-city, Japan.

Background: Japan has the second highest prevalence of dialysis use in the world. Approximately 40% of patients who begin dialysis have diabetic kidney disease (DKD). Local governments and medical facilities are required to provide preventive measures against worsening diabetes mellitus (DM). However, the percentage of patients with DM who receive such screening or interventions for DKD is unclear. This study aimed to reveal to what extent screening for DKD and preventive measures against worsening DKD are performed in patients with DM, using an administrative database in a municipality.
Methods: This was a cross-sectional study that used the Kyoto-city's administrative medical and long-term care database. Patients with a diagnosis of DM and receiving antidiabetic medication between 2013 and 2018 were defined as patients with DM and included. Patients with DKD were defined as those diagnosed with diabetic nephropathy or those with chronic kidney disease. We described the characteristics of patients with DM, diabetic complications, and extent of DKD screenings and preventive efforts against worsening of DM by fiscal year.
Results: Across fiscal years, 25.8% to 27.5% of patient with DM had DKD. More than 3% of patients were on dialysis due DM in each fiscal year; approximately 15% started receiving dialysis that year. The percentage of patients who were regularly prescribed antidiabetic medication and received glycosylated hemoglobin testing ranged from 64.0% to 67.2% and from 30.6% to 36.5%, respectively. Urine microalbuminuria testing at least once a year occurred in 9.3% to 10.0%. The percentage of patients who received nutritional guidance ranged from 19.0% to 21.0%. Approximately 1% of patients received guidance for preventing DM from progressing to a disease that requires dialysis each fiscal year.
Conclusion: This study from Japan, where a super-aging society has developed, using an administrative database in a municipality covering most of the elderly population clearly demonstrated an evidence-practice gap in efforts to prevent worsening of DKD. Strengthening cooperation between government and medical facilities and support for providing preventive measures against DKD are urgently needed.
Competing Interests: Author MKU is employed by the company Healthtech Laboratory, Inc. TS and YuT are employed by the Kyoto University and HealthTech Laboratory Inc., Joint Research Fund. TI is an unpaid external director of HealthTech Laboratory Inc. and reported receiving joint research grants from Healthtech Laboratory Inc. and TIS Inc. YoT reported receiving grants from the Japan Society for the Promotion of Science during the study. TN reported receiving grants from I&H Co. Ltd. and Nakagawa Pharmacy Co. outside of the submitted work and fees from Otsuka Pharmaceutical Co., Pfizer Japan Inc., Merck & Co. KK, Chugai Pharmaceutical Co., Takeda Pharmaceutical Co., Janssen Pharmaceutical KK, Boehringer Ingelheim International GmbH, Eli Lilly Japan KK, Baxter Ltd., Mitsubishi Tanabe Pharma Co., Novartis Pharma KK, and Allergan Japan KK outside of the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from a joint research grant from Healthtech Laboratory Inc. and Kyoto University, a joint research grant from Healthtech Laboratory Inc., Towa Pharmaceutical Co., Ltd., and TIS Inc., and a joint research grant from Kyoto University, Healthtech Laboratory Inc., and TIS Inc. The funders (Healthtech, Laboratory Inc., Towa Pharmaceutical Co., Ltd., and TIS Inc.) had the following involvement in the study: participation in the construction of the concept of the study, study design, analysis, and preparation of the manuscript.
(Copyright © 2023 Tateyama, Shimamoto, Uematsu, Taniguchi, Nishioka, Yamamoto, Okada, Takahashi, Nakayama and Iwami.)