Approach toward diabetic nephropathy and its management in patients with type 2 diabetes: results of a web-based italian survey

AIM The purpose of this survey was to investigate the attitudes and clinical approach of Italian diabetologists toward diabetic nephropathy (DN). METHODS A 28-item web survey was distributed to Italian diabetologists by the Associazione Medici Diabetologi. The first part of the questionnaire was aimed at describing the sample of clinicians involved (age, gender, practice setting, etc.). The second part analyzed more deeply the clinical approach to DN. RESULTS Two hundred and thirty-five clinicians, expert in the field (over 44% have been working as diabetologists for more than 20 years) and well distributed across the country, participated in the survey. The lack of medical care provided from a team remains a main concern, since only in a minority of diabetes centers diabetologists can collaborate with health professionals with expertise and a special interest in diabetes. Screening of DN is performed at first visit by 95% of participants. Urinary albumin creatinine ratio and estimated glomerular filtration rate by CKD-EPI are two approaches used. The relevance of intensive glycemic treatment respect to the onset and progression of DN is mostly considered in patients with microalbuminuria, less frequently in patients with more advanced kidney disease. Almost the totality of participants prescribes renin angiotensin system blocking drugs for the treatment of hypertension, mainly in presence of albuminuria. This class of drugs is less frequently recommended in normotensive patients with microalbuminuria. Regarding the new anti-hyperglycemic drugs, more attention is paid for SGLT2 inhibitors or GLP-1 receptor agonist. CONCLUSIONS The present survey highlights the clinical relevance of DN and the high attention for this diabetic complication by Italian diabetologists. Although the lack of medical care provided from a team remains a main concern, the diabetologists are engaged in promoting educational and screening programs. They are also in keeping with guidelines in choosing antihypertensive treatment or new antihyperglycemic drugs showing to protect kidney function. Finally, participants to the survey declare that they are willing to collaborate with nephrologists, mainly in the more advanced stage of DN. KEY WORDS diabetes mellitus; chronic kidney disease; SGLT2 inhibitors; GLP-1 receptor agonist; diabetic nephropathy.