Background: The prevalence of diabetes is increasing in epidemic proportions worldwide. Patients with diabetes are surviving vascular events, living longer, and thus experiencing other adverse outcomes. In the UK despite considerable investments in primary care aimed at identifying and treating CKD in patients with diabetes, CKD is often under-diagnosed and undertreated. Understanding this gap in the implementation and delivery of existing interventions in the UK is the most important purpose of this project.
Objectives: 1. Multicentre, series of cross-sectional studies between 2006 and 2010 to describe variations in screening for CKD and resulting treatment as carried out in diabetes after the inclusion of CKD as one of the financially incentivised chronic disease management targets in the Quality and Outcomes Framework, a major pay for performance incentive in UK primary care. We aim to examine the association between patient and practice related factors and screening for CKD, resulting treatment by GPs and process of care measures. 2. Cohort study of incident patients with diabetes with or without CKD followed up over 5 years in order to describe a) longitudinal decline of renal function, b) cardiovascular events, c) all-cause mortality and d) hip fracture. We aim to identify patient and practice-related factors associated with adverse outcomes.
Data: Quality Improvement in Chronic Kidney Disease dataset (930,000 patients in 129 general practices) in England.
Expected results: Our research would provide population-based data on key indicators for health care systems of CKD management in diabetes for the first time after specific interventions were instituted in the UK. We aim to describe for the first time whether nationwide interventions targeting surrogate endpoints in people with diabetes had an effect on adverse clinical outcomes such as cardiovascular events, mortality and progression of CKD.
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