Diabetes Obesity and Metabolism, Год журнала: 2024, Номер 26(11), С. 4813 - 4815
Опубликована: Сен. 2, 2024
Язык: Английский
The Lancet Diabetes & Endocrinology, Год журнала: 2024, Номер 12(8), С. 569 - 595
Опубликована: Июль 23, 2024
Язык: Английский
Процитировано
29
JAMA Internal Medicine, Год журнала: 2024, Номер 184(7), С. 737 - 737
Опубликована: Апрель 15, 2024
Large gaps in clinical care patients with chronic kidney disease (CKD) lead to poor outcomes.
Язык: Английский
Процитировано
10
Nature Reviews Nephrology, Год журнала: 2024, Номер 20(6), С. 386 - 401
Опубликована: Март 15, 2024
Язык: Английский
Процитировано
7
Australian Prescriber, Год журнала: 2024, Номер 47(1), С. 15 - 19
Опубликована: Фев. 19, 2024
Therapeutic inertia, sometimes referred to as clinical has been defined failure initiate or intensify therapy when therapeutic goals are not reached. Lack of initiation intensification treatment according guidelines linked suboptimal control a range chronic conditions. Clinician factors contributing inertia include knowledge gaps; discomfort with uncertainty about the diagnosis, target, evidence; concerns safety intensification; and time constraints. Patient characteristics that may be associated male sex, older age, lower life expectancy, multiple comorbidities parameters close target. There reasons other than explain apparent undertreatment. Apparent in prescribing accompanied by appropriate actions, such provision lifestyle advice interventions promote adherence existing medication. Some patients choose treatment. Interventions reduce access evidence-based point-of-care tools, preferably integrated record systems; clinician education including educational visits; reminders; audits feedback reflection on practice; shared decision-making; prompting patients; ambulatory home monitoring (e.g. blood pressure monitoring).
Язык: Английский
Процитировано
6
Journal of the American College of Cardiology, Год журнала: 2024, Номер 84(8), С. 683 - 693
Опубликована: Авг. 1, 2024
Язык: Английский
Процитировано
6
Advances in Therapy, Год журнала: 2024, Номер 41(10), С. 3757 - 3770
Опубликована: Авг. 20, 2024
Early-stage (stage 1–3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their status and remain undiagnosed. is associated multiple long-term conditions (MLTC), or multimorbidity, the common these being cardiovascular disease, hypertension, type 2 diabetes. Primary care practitioners (PCPs) crucial in early identification management patients CKD. For individuals at high risk CKD, measurements estimated glomerular filtration rate, urine albumin–creatinine ratio, blood pressure should be obtained regularly recorded a timely manner. The importance lifestyle changes prevention also highlighted. A recent addition to treatment without diabetes been recommendation by clinical practice guidelines sodium–glucose co-transporter (SGLT2) inhibitor alongside renin–angiotensin–aldosterone system as foundational therapy. SGLT2 inhibitors prevent progression reduce fatal non-fatal events, hospitalization for heart failure, all-cause mortality, they have favorable safety tolerability profile. However, uptake slow, particularly multifaceted approach required ensure receive optimal protection. Measures raise awareness intervention include local/national campaigns via social media practice-based education; education programs; integration decision support tools into electronic health records; detection programs built around good interdisciplinary communication. PCPs forefront multidisciplinary best placed implement evidence-based modification guideline-directed medical Chronic affects about one ten adults worldwide. Results from many real-world studies show getting worse. because can no symptoms its stages, it often not diagnosed. Many therefore it. People likely other issues well, including hypertension offer holistic, patient-centered those frontline identifying managing factors disease. may advise on changes, diet exercise, well helping them understand what treatments available. Sodium–glucose shown strong kidney-protective effects trials, recently updated recommend use therapy more established These prescribed whether not. primary obtain record function pressure. Public practitioner education, tools, communication between healthcare professionals all important drive change improve
Язык: Английский
Процитировано
6
Diabetes Therapy, Год журнала: 2023, Номер 14(7), С. 1111 - 1136
Опубликована: Май 20, 2023
Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have high risk developing cardiovascular end-stage disease, there need for early detection initiation appropriate therapeutic interventions that slow progression prevent adverse outcomes. Due to complex nature diabetes CKD management, holistic, patient-centered, collaborative care approach delivered by coordinated multidisciplinary team (ideally including clinical pharmacist as part comprehensive medication management program) needed. In this review, we discuss barriers effective care, current used prevention treatment, potential ways type 2 mellitus can be refined improve patient People living are at disease. Having means over time kidneys may not work well they should. Some people will eventually new (transplant) or use machine does job their (dialysis). To rate which get worse, needs detected treated early. A healthcare professionals needed help reduce chances getting from worse. teams include who makes sure medicines given in correct amount time. It important members communicate person family caregivers (if needed) decision-making process achieve better health results. Barriers stopping good shortage nephrologists, having enough insurance, limited access healthcare, poor understanding about what how it treated. This review article discusses could changed
Язык: Английский
Процитировано
14
Nature Reviews Nephrology, Год журнала: 2024, Номер 20(3), С. 147 - 148
Опубликована: Янв. 18, 2024
Язык: Английский
Процитировано
4
Canadian Journal of Kidney Health and Disease, Год журнала: 2025, Номер 12
Опубликована: Янв. 1, 2025
Background: Diabetes is the leading cause of kidney disease and contributes to 38% failure requiring dialysis. A gap in detection management type 2 diabetes (T2D) chronic (CKD) exists primary care. Community pharmacists are positioned support those not able access care through traditional pathways. Algorithms were developed validated assist community identifying individuals with T2D CKD prescribing kidney-protective medications. Objective: The objective was develop validate pharmacist algorithms confirm prescribe guideline-directed therapies for an estimated glomerular filtration rate (eGFR) 30 60 mL/min/1.73 m² pharmacy clinics Nova Scotia. Design: Lynn’s method utilized algorithm development content validation. Interview data analyzed using qualitative descriptive analysis. Setting: Pharmacists working clinic settings completed face validation, virtual interviews conducted following each round Patients: aim by optimizing resources capacity while ensuring safety quality a team-based approach. Patient partners part Measurements: Content validity computed item-level index (I-CVI) scale-level (S-CVI/Ave) per round. To measure validity, percentages that “agreed” or “strongly agreed” five statements calculated. Methods: Evidence- expert-informed revised 3-step (domain identification, item generation domain, instrument formation). Best evidence collated literature searches, experts nephrology, endocrinology, family medicine, nursing, until there consensus agreement on 4 final (detection CKD, initiation/titration angiotensin-converting enzyme inhibitors angiotensin receptor blockers, initiation/management sodium-glucose cotransporter-2 finerenone). Six 3 rounds needed algorithms. 2-part questionnaire where rated Likert scales. I-CVI S-CVI/Ave across determined. Percentages calculated rating level 5 statements. Interviews analyzed. Revisions made between rounds. Results: Eighteen (6 round) participated mean ± standard deviation 18 ±11 years experience. ranged from 0.83 1, which met threshold ( P < .05) at least 6 participants. overall 0.97. percentage participants who agreed strongly 83% 100%, above prespecified consensus. Limitations: intended eGFR mL/min/1.73m². While guideline medications indicated below this threshold, cut point selected as these should typically be referred nephrologist. There potential delays initiation waiting seen nephrology. Conclusions: This first study new model utilizes identify manage achieved high validity. Future implementation evaluation will determine effectiveness Trial Registration: Not registered.
Язык: Английский
Процитировано
0
Journal of Diabetes and its Complications, Год журнала: 2025, Номер 39(4), С. 108985 - 108985
Опубликована: Март 1, 2025
Язык: Английский
Процитировано
0