Impact of Point of Care Albuminuria on Therapeutic Inertia in Patients with Type 2 Diabetes and Hypertension
Bibliographic record
Abstract
Objective: Therapeutic inertia in type 2 diabetes (T2D) is particularly evident for albuminuria that does not receive full attention from treating practitioners.Our objective was to assess whether we could help overcome therapeutic inertia of T2D hypertensive patients with a point of care measure of blood pressure and albuminuria on quality of care.Methodology: CLINPRADIA (CLINical PRActice in DIAbetes (NCT01907958)) was a multicenter randomized trial in family practice clinics in Canada to evaluate the impact of introducing a device allowing a point-of-care testing (POCT) of urinary albumin excretion to usual practice on the management of albuminuria in T2D patients with hypertension.A total of 8 sites (4 in Quebec and 4 in Ontario) with at least 5 general practitioners each were involved in the study totaling 243 patients with uncontrolled hypertension (i.e., BP>130/80 mmHg) who were followed for a period of 12 months.The clinics that had access to the POCT of blood pressure and albuminuria at some point during the study formed the intervention group while the clinics that did not have access to the information at any time during the study were included in the control group.Results: Baseline characteristics of control and intervention groups were not different in age, sex, blood pressure (BP), blood glucose control and kidney function.By the end of the study, the decrease in albuminuria from log ACR 0.357 to 0.017 was significant (p<0.002) in the intervention group only.Its lowering was more significant (p<0.01) with ACEi or ARBs combined with CCB than with the medications alone or with any other medications.These combinations led also to a significant reversal of eGFR decline.At the end of the study, the average SBP were 129 and 137 mmHg in the intervention and control groups, respectively (difference p=0.004), so that more patients had their blood pressure controlled in the intervention group.Conclusion: Provision of timely information of blood pressure and albuminuria levels of T2D patients helped overcome therapeutic inertia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".