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논문분류	춘계학술대회 초록집
제목	Implementation of the 2022 Diabetes Guideline: Progress and Barriers
저자	Juliana Chan
출판정보	2024; 2024(1):
키워드
초록	Diabetes is the leading cause of kidney failure (KF) due to a myriad of genetic, epigenetic and lifecourse factors causing a clustering of cardiovascular-kidney-metabolic risk factors. This results in loss of structure and function of the nephrons with progressive increase in albuminuria and decline in glomerular filtration rate. High blood glucose, blood pressure and adiposity activate the renin-angiotensin aldosterone system (RAAS) causing kidney inflammation and fibrosis. This is made worse by the trafficking of glucose and sodium across renal tubules resulting in tubular damage and abnormal haemodynamics. Yet, there are conclusive evidence showing that CKD and KF are preventable and treatable. However, due to the silent, progressive and complex nature of diabetes and CKD, regular multisystem assessment for microvascular complications and CKM factors is essential to drive early actions. These include the use of organ-protective medications such as metformin, RASi, nsMRA, SGLT2i and GLP1-RA along with control of multiple risk factors. Each person with diabetes has a unique set of risk profiles for individualized treatment. The systematic data collection every 1-2 years provides quality assurance, stratifies risks and promotes shared decision-making between patients and providers. To implement these protocol-driven assessments effectively requires change of setting, redesign of workflow and task delegation. For a person living with diabetes, these regular assessments (eye, feet, blood, urine) empowers the patients to manage their risks and own their health, enables the care team to identify care gaps and increases the transparency of care standards during co-management by multiple teams. This integrated risk assessment and management programs have been proven to reduce adverse clinical outcomes. The linking of these registers to hospitalization data can inform the payors regarding the value of these programs for scaling and adaptation according to the local healthcare and financing system, which will reduce the burden of diabetes complications including CKD.
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