{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:20:42Z","timestamp":1791498042715,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/Hypothesis<\/jats:title>\n                    <jats:p>To identify gaps and inconsistencies in the coding and testing of chronic kidney disease (CKD) among people with type 2 diabetes mellitus in UK primary care by evaluating clinical inertia in those with reduced estimated glomerular filtration rate (eGFR) and\/or elevated urine albumin\u2010creatinine ratio (uACR) levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cross\u2010sectional analysis using SystmOne and the PARM Diabetes tool. A cohort from two primary care settings was screened to identify type 2 diabetes mellitus patients with eGFR &lt;60\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      on two occasions. A retrospective analysis evaluated CKD coding accuracy per NICE guidelines, identifying gaps in coding and testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant variation was observed in CKD monitoring and diagnosis between the two settings. Overall, 77.3% had eGFR testing, and 37.6% had uACR testing within the past 12\u2009months, with significantly higher testing rates in primary care setting one (urban) compared to primary care setting two (rural). Only 35% of patients received both tests within the past 12\u2009months, with the lowest uptake among patients under 60\u2009years (28%) and those with advanced CKD stages. Among patients with \u22652 eGFR readings &lt;60\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      , 61% remained uncoded for CKD if they had exactly two readings, compared to 15% uncoded among those with more than two. Coding rates increased with age but did not differ significantly between settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study emphasises the need for increased uACR testing and CKD coding in type 2 diabetes mellitus patients to ensure accurate monitoring and management. Fluctuating eGFR\/ACR levels and process issues may contribute to clinical inertia. These findings specifically highlight gaps in CKD monitoring and diagnosis, particularly in younger patients and rural settings. We recommend healthcare professionals review coding practices and follow CKD guidelines to improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70254","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:00:12Z","timestamp":1770897612000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Chronic kidney disease in type 2 diabetes in\n                    <scp>UK<\/scp>\n                    primary care: Testing frequency, coding accuracy and clinical inertia"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4344-3915","authenticated-orcid":false,"given":"A.","family":"Zafar","sequence":"first","affiliation":[{"name":"NIHR Leicestershire and Northamptonshire Commercial Research Delivery Centre  Leicester UK"},{"name":"Diabetes and Cardiovascular Medicine, Faculty of Health, Education and Society University of Northampton  Northampton UK"},{"name":"Primary Care Research Hub Danes Camp Medical Centre Research and Training Academy  Northampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9497-9460","authenticated-orcid":false,"given":"C.","family":"Scarlata","sequence":"additional","affiliation":[{"name":"NIHR Leicestershire and Northamptonshire Commercial Research Delivery Centre  Leicester UK"},{"name":"Primary Care Research Hub Danes Camp Medical Centre Research and Training Academy  Northampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Jaleel","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology Northampton General Hospital  Northampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-21-0097"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13098-023-01202-x"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvad083"},{"key":"e_1_2_11_5_1","unstructured":"National Institute for Health and Care Excellence.Chronic kidney disease: assessment and management: NICE guideline [NG203].https:\/\/www.nice.org.uk\/guidance\/ng203\/chapter\/recommendations#investigations\u2010for\u2010chronic\u2010kidney\u2010disease"},{"issue":"1","key":"e_1_2_11_6_1","first-page":"25","article-title":"The importance of early identification of chronic kidney disease","volume":"108","author":"Whaley\u2010Connell A","year":"2011","journal-title":"Mo Med"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2023.0079"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02438-6"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/cd23-0074"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-023-02482-5"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-064513"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X704105"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-024-03555-0"},{"key":"e_1_2_11_14_1","unstructured":"NitschD CaplinB HullS WheelerD.National chronic kidney disease audit\/\/national report (part 1).2017.https:\/\/www.lshtm.ac.uk\/files\/ckd_audit_report.pdf"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X713105"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2023.10.005"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2010.07.003"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2017.12.007"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22094824"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac283"},{"key":"e_1_2_11_21_1","unstructured":"NICE.Chronic kidney disease: assessment and management. NICE NG203.https:\/\/www.nice.org.uk\/guidance\/ng203"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/21501319241305968"},{"key":"e_1_2_11_24_1","unstructured":"Charley Coleman.Health care in rural areas.https:\/\/lordslibrary.parliament.uk\/health\u2010care\u2010in\u2010rural\u2010areas\/"},{"key":"e_1_2_11_25_1","unstructured":"National Institute for Health and Care Excellence.Diabetes (type 1 and type 2) in children and young people: diagnosis and management [NG18].https:\/\/www.nice.org.uk\/guidance\/ng18\/chapter\/Recommendations#monitoring\u2010for\u2010complications\u2010and\u2010associated\u2010conditions\u2010of\u2010type\u20102\u2010diabetes"},{"key":"e_1_2_11_26_1","unstructured":"NHS Digitial.National diabetes audit: young people with type 2 diabetes 2022\u201323.https:\/\/digital.nhs.uk\/data\u2010and\u2010information\/publications\/statistical\/national\u2010diabetes\u2010audit\u2010yt2"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.02.335"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-021-05494-4"},{"key":"e_1_2_11_29_1","unstructured":"StrainW.Clinical inertia affects younger and older adults with type 2 diabetes mellitus equally with or without CKD.2015.https:\/\/www.easd.org\/media\u2010centre\/home.html"},{"key":"e_1_2_11_30_1","doi-asserted-by":"crossref","unstructured":"ZafarW HuY BrubakerL HarshawN GreenJ ChangAR.Impact of smartphone\u2010enabled home urinary albumin\u2010to\u2010creatinine ratio testing on albuminuria screening and management.medRxiv. 2025:2025.06.11.25329440.10.1101\/2025.06.11.25329440","DOI":"10.1101\/2025.06.11.25329440"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00876-0"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2016.05.160020"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204233"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2025845"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000259.pub3"},{"key":"e_1_2_11_37_1","first-page":"912","article-title":"Accuracy and completeness of clinical coding using ICD\u201010 for ambulatory visits","volume":"2017","author":"Horsky J","year":"2018","journal-title":"AMIA Annu Symp Proc"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare4030036"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70254","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.70254","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70254","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:27:34Z","timestamp":1777688854000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.70254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/dme.70254"],"URL":"https:\/\/doi.org\/10.1111\/dme.70254","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"assertion":[{"value":"2025-09-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70254"}}