Quality of care in patients with diabetic kidney disease in Asia: The Joint Asia Diabetes Evaluation (JADE) Registry.
Diabetic kidney disease independently predicts cardiovascular disease and premature death. We examined the burden of chronic kidney disease (CKD, defined as an estimated GFR < 60 ml/min/1.73 m(2) ) and quality of care in a cross-sectional survey of adults (age ≥ 18 years) with Type 2 diabetes across Asia.



The Joint Asia Diabetes Evaluation programme is a disease-management programme implemented using an electronic portal that systematically captures clinical characteristics of all patients enrolled. Between July 2007 and December 2012, data on 28 110 consecutively enrolled patients (China: 3415, Hong Kong: 15 196, India: 3714, Korea: 1651, Philippines: 3364, Vietnam: 692, Taiwan: 78) were analysed.



In this survey, 15.9% of patients had CKD, 25.0% had microalbuminuria and 12.5% had macroalbuminuria. Patients with CKD were less likely to achieve HbA1c < 53 mmol/mol (7.0%) (36.0% vs. 42.3%) and blood pressure < 130/80 mmHg (20.8% vs. 35.3%), and were more likely to have retinopathy (26.2% vs. 8.7%), sensory neuropathy (29.0% vs. 7.7%), cardiovascular disease (26.6% vs. 8.7%) and self-reported hypoglycaemia (18.9% vs. 8.2%). Despite high frequencies of albuminuria (74.8%) and dyslipidaemia (93.0%) among CKD patients, only 49.0% were using renin-angiotensin system inhibitors and 53.6% were on statins. On logistic regression, old age, male gender, tobacco use, long disease duration, high HbA1c , blood pressure and BMI, and low LDL cholesterol were independently associated with CKD (all P < 0.05).



The poor control of risk factors, suboptimal use of organ-protective drugs and high frequencies of hypoglycaemia highlight major treatment gaps in patients with diabetic kidney disease in Asia.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
A O
AO
Luk
Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.
X
X
Li
Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.
Y
Y
Zhang
Department of Endocrinology, Peking University First Hospital, Beijing, China.
X
X
Guo
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
W
W
Jia
Peking Union Medical College Hospital, Beijing, China.
W
W
Li
The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, Beijing, China.
J
J
Weng
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
W
W
Yang
Qualigenics Diabetes Centre, Hong Kong SAR, China.
W B
WB
Chan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
R
R
Ozaki
Alice Ho Nethersole Hospital, Hong Kong SAR, China.
C C
CC
Tsang
Dr M.K. Mukhopadhyay's Diabetic Clinic, Kolkata.
M
M
Mukhopadhyay
ILS Hospital, Salt Lake, India.
A K
AK
Ojha
Hallym University College of Medicine, Gangwon-do, Korea.
E G
EG
Hong
The Catholic University of Korea, Seocho-gu, Korea.
K H
KH
Yoon
Heart of Jesus Hospital, San Jose City, Philippines.
L
L
Sobrepena
Senor Sto. Nino Hospital, Tarlac, Philippines.
R M
RM
Toledo
New Bilibid Prison Hospital, Bureau of Corrections, Muntinlupa, Philippines.
M
M
Duran
Taichung Veterans General Hospital, Taichung, Taiwan.
W
W
Sheu
Bach Mai Hospital, Hanoi, Vietnam.
T
T
Q Do
HCMC University of Pharmaceutical and Medicine, Ho Chi Minh City, Vietnam.
T K
TK
Nguyen
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
R C
RC
Ma
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
A P
AP
Kong
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China.
C C
CC
Chow
Qualigenics Diabetes Centre, Hong Kong SAR, China.
P C
PC
Tong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
W Y
WY
So
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.
J C
JC
Chan
D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000378:metabolism; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000209:etiology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000209:etiology; D050171:Dyslipidemias / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015999:Multivariate Analysis; D010679:Philippines / Q000453:epidemiology; D011787:Quality of Health Care; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D056910:Republic of Korea / Q000453:epidemiology; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D064424:Tobacco Use / Q000453:epidemiology; D014744:Vietnam / Q000453:epidemiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D000451:Mineralocorticoid Receptor Antagonists; C517652:hemoglobin A1c protein, human