IDF21-0197 Take CaRe of Me Programme: Gaps in Early Diagnosis of Cardiorenal Complications in Type 2 Diabetes from 6 Countries

Background: Gaps exist in early identification and prevention of cardiorenal complications (CRCs) in type 2 diabetes (T2D). Aim: To investigate global variations in burden and treatment patterns of CRCs, including albuminuria, high cardiovascular (CV) risk, and early echocardiographic findings, among individuals with T2D in primary care settings. This is an ongoing patient-centric program that collects data on early diagnostic tests during disease journey to support critical decision-making. Method: ‘Take CaRe of Me’, a subset of DISCOVER CaReMe Registry, is a multicountry, prospective, cloud-based data repository on routine care for adults (>18 years) with T2D, without cardiorenal disease history at screening (per medical records). We present preliminary descriptive analysis (until May-2021) from 6 countries. Results: Among 4686 patients (mean age: 55.7±11.3 years; 46.2% men), average T2D duration was 8.4±7.2 years (N=4534) and mean glycated hemoglobin (HbA1c) was 8.3±3.0% (N=4409). About 32.3% had total cholesterol >180mg/dL (N= 4362); 51.4% had low-density lipoprotein cholesterol >70mg/dL (N=3985). Mean estimated glomerular filtration rate was 94.6±23.2mL/min/1.73m2 (N=479) and mean urine albumin:creatinine ratio (UACR) was 62.9±181.9mg/g (N=3869). Overall, 66.3% had HbA1c >7%; as per UACR and European Society of Cardiology (ESC) 2019, 32.7% had high renal risk (UACR >30mg/g), and 37.0% had high/very high CV risk (Table 1). On echocardiography (N=417), 8.9% (n=37) had diastolic dysfunction, 20.6% (n=86) had left ventricular hypertrophy, 16.5% (n=69) had left atrial enlargement, and 8.6% (n=36) had valvular diseases. Among high/very high CV risk (N=1861) and high renal risk (N=1390), biguanides were most commonly prescribed antidiabetics in all lines of therapy (n=502, 26.9%; n=346, 24.8%), followed by biguanides+sulfonylureas (n=154, 8.3%; n=126, 9.1%), respectively. As first-line therapy, 42.4% (693/1635) with high/very high CV risk, 44.6% (531/1191) with high renal risk, and 44.2% (518/1172) with both risks received antidiabetics; around 2% of them received dipeptidyl peptidase-4 inhibitors (DPP-4i), sodium-glucose cotransporter-2 inhibitors (SGLT2i) or DPP4i+SGLT2i. Overall, less than 2% of patients with high/very high CV or renal or both risks received glucagon-like peptide-1 agonists. Other therapies (N=4229) included antilipids (98.4%), antihypertensives (23.2%), and antiplatelets (2.4%).Table 1Glycemic Control and CRCs in T2DOverallArgentinaEgyptIndiaMalaysiaMexicoPhilippinesn(%)HbA1c(%)N=4409N=389N=193N=1650N=30N=1573N=574<71488(33.7)170(43.7)65(33.7)557(33.8)11(36.7)470(29.9)215(37.5)7-102012(45.6)169(43.4)94(48.7)788(47.8)14(46.7)707(44.9)240(41.8)>10909(20.6)50(12.9)34(17.6)305(18.5)5(16.7)396(25.2)119(20.7)UACR(mg/g)*N=3869N=339N=157N=1509N=29N=1561N=274A1(<30)2605(67.3)244(72)100(63.7)927(61.4)17(58.6)1171(75%)146(53.3)A2(30-300)1104(28.5)89(26.3)52(33.1)508(33.7)11(37.9)332(21.3)112(40.9)A3(>300)160(4.1)6(1.8)5(3.2)74(4.9)1(3.4)58(3.7)16(5.8)CV risk*N=4686N=399N=196N=1671N=30N=1618N=772Low2592(55.3)190(47.6)87(44.4)825(49.4)15(50)972(60.1)503(65.2)Moderate362(7.7)11(2.8)14(7.1)196(11.7)2(6.7)87(5.4)52(6.7)High/Very High1732(37)198(49.6)95(48.5)650(38.9)13(43.3)559(34.5)217(28.1)*Risk defined per UACR and ESC 2019. Open table in a new tab *Risk defined per UACR and ESC 2019. Discussion: Among patients with T2D without cardiorenal disease, 32.7% and 37.0% had early signs of high renal risk and high/very high CV risk. Thus, channeling attention to early markers like UACR and echocardiography through enhanced screening enables timely diagnosis and adequate treatment with novel antihyperglycemics that also reduce cardiorenal risk at an early stage.