Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease

Clement Lo, Edward Zimbudzi, Helena J. Teede, Peter G. Kerr, Sanjeeva Ranasinha, Alan Cass, Gregory Fulcher, Martin Gallagher, Kevan R. Polkinghorne, Grant Russell, Tim Usherwood, Rowan Walker, Sophia Zoungas

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    Abstract

    Aims: In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets. 

    Methods: This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to <60 ml/min/1.73m2) across four hospitals. We combined clinical data with results from a questionnaire comprising measures of patient-identified barriers to care, the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), and the Summary of Diabetes Self-Care Activity (SDSCA). 

    Results: 199 patients, mean age 68.7 (SD 9.6), 70.4% male and 90.0% with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported “poor family support” (OR 4.90; 95% CI 1.80 to 13.32, p < 0.002). Poor BP control was associated with increased odds of patient reported, “not having a good primary care physician” (OR 6.01; 2.42 to 14.95, p < 0.001). The number of barriers was not associated with increased odds of poor control (all p > 0.05). 

    Conclusions: Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.

    Original languageEnglish
    Pages (from-to)63-68
    Number of pages6
    JournalJournal of Diabetes and Its Complications
    Volume33
    Issue number1
    Early online date12 Oct 2018
    DOIs
    Publication statusPublished - Jan 2019

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    Lo, C., Zimbudzi, E., Teede, H. J., Kerr, P. G., Ranasinha, S., Cass, A., Fulcher, G., Gallagher, M., Polkinghorne, K. R., Russell, G., Usherwood, T., Walker, R., & Zoungas, S. (2019). Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease. Journal of Diabetes and Its Complications, 33(1), 63-68. https://doi.org/10.1016/j.jdiacomp.2018.09.020