Evaluation Reveals Gaps in Diabetes and CKD Medication Therapy

Prescribing Gaps Found in Veteran Health Indiana Diabetes and Kidney Care

Primary care prescribing practices for veterans with chronic kidney disease and type 2 diabetes frequently miss guideline-directed medication therapy targets, according to a recent evaluation. Investigators examined patient charts at Veteran Health Indiana to measure alignment with the 2024 Kidney Disease: Improving Global Outcomes guidelines. The retrospective review identified distinct gaps in the adoption of guideline-directed medications designed to slow disease progression.

The study evaluated a random sample of patients who received care at Veteran Health Indiana Primary Care between July 1, 2022, and July 1, 2024. Researchers excluded individuals who were followed by a renal or nephrology clinic, patients who had type 1 diabetes, and those who died during the two-year study window. Out of 125 included patient charts, investigators tracked the utilization rates of three primary drug classes recommended for dual chronic kidney disease and diabetes management.

Medication Utilization Rates Among Evaluated Veterans

Renin-angiotensin-system inhibitor therapy showed the highest uptake among the cohort. A total of 117 patients, representing 93.6% of the sample, received RASi medications. Sodium-glucose cotransporter-2 inhibitor therapy reached lower utilization, with 85 patients or 68.0% prescribed an SGLT2i. Nonsteroidal mineralocorticoid receptor antagonist therapy recorded the lowest adoption rate, with only 5 patients, or 4.0%, using ns-MRA therapy.

When analyzing missing treatments where no documented reason existed, the study found distinct differences across drug categories. Five patients lacked RASi medications without a recorded justification. Meanwhile, 32 patients did not receive SGLT2i therapy, and 37 patients lacked ns-MRA therapy for unknown clinical reasons.

Secondary Outcomes and Pharmacist Management

The review also tracked secondary measures, including appropriately monitored laboratory values, mean differences in albumin-to-creatinine ratios, and estimated glomerular filtration rates. Researchers additionally recorded the percentage of patients followed directly by a clinical pharmacist for diabetes management. Closing these existing medication gaps remains a primary focus for improving clinical outcomes, as consistent use of guideline-directed therapy slows advancement toward kidney failure and reduces associated morbidity and mortality.

Which patient records and clinical guidelines investigators analyzed