Characterization of Patients With Type 2 Diabetes and Chronic Kidney Disease in a Large Integrated Health System

Background: Chronic kidney disease (CKD) poses substantial clinical, economic, and humanistic burden in patients with type 2 diabetes (T2D). Understanding of how to optimize patient care and slow disease progression is warranted. Objective: To compare the prevalence, clinical characteristics, treatment patterns, and healthcare utilization among patients with CKD, T2D, or CKD associated with T2D. Design: Retrospective cross-sectional analysis. Patients: Adult patients with CKD, T2D, or CKD+T2D in the Cleveland Clinic Health System.Main Measures: Clinical characteristics, laboratory measures, medication utilization, cardiometabolic management and healthcare resource utilization.Key Results: In 2019, 122,276 patients were identified as CKD, 63,643 were identified as T2D, and 35,255 were identified as having CKD associated with T2D. Patients with CKD and CKD+T2D were observed to be older than those with T2D alone, 72.6, 72.2, and 63.0 years, respectively. T2D and T2D+CKD cohorts contained a higher percentage of males vs. those with CKD alone, 49.3%, 50.8%, 43.6%, respectively. ACEi/ARB therapy was observed in 27.7%, 42.4%, and 31.5% patients with CKD, T2D+CKD, and T2D, respectively. SGLT-2i therapy was only prescribed to a minority of patients with T2D (5.8%) and T2D+CKD (4.7%). Emergency department visits and hospital admissions were more prevalent in the group with CKD (26.5%, 52.9%) or CKD+T2D (28.8%, 54.9%) vs. T2D alone (18.6%, 41.8%), respectively. The majority of patients with CKD (90.4%), CKD+T2D (60.0%) or T2D (69.1%) did not have an assessment of urine protein. Conclusions: Patients with CKD+T2D or CKD have higher healthcare resource utilization than those with T2D alone. The majority of patients with CKD, CKD+T2D or T2D do not undergo assessment of urine protein and are under prescribed ACEi/ARB therapy. SGLT-2i therapy was prescribed to only a small minority of patients with T2D or CKD+T2D. An opportunity exists to improve the care of patients with CKD, both with and without T2D.