Blood glucose and pressure controls in diabetic kidney disease: Narrative review of adherence, barriers and evidence of achievement

• Published in: Journal of diabetes and its complications 2018-01, Vol.32 (1), p.104-112
• Main Authors: Gardiner, Fergus William, Nwose, Ezekiel Uba, Bwititi, Phillip Taderera, Crockett, Judith, Wang, Lexin
• Format: Article
• Language: English
• Subjects: Achievement; Australia - epidemiology; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - standards; Blood Glucose Self-Monitoring - statistics & numerical data; Blood pressure; Blood Pressure - physiology; Blood Pressure Determination - standards; Blood Pressure Determination - statistics & numerical data; Chronic kidney disease; Clinical management; Clinical practice guidelines; Communication Barriers; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - therapy; Diabetic Nephropathies - blood; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - physiopathology; Diabetic Nephropathies - therapy; Diabetic nephropathy; Disease management; Evidence-Based Practice - statistics & numerical data; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Humans; Hypertension; Kidney diseases; Patient Care Planning - statistics & numerical data; Patient compliance; Renal disease; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2017.09.008

To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control. Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience. There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes. It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage.