TOPLINE:

Real-world clinical data from Finland revealed that although diabetes and diabetic kidney disease were common, many patients missed recommended kidney screening and discontinued indicated treatments, resulting in underdiagnosis, inadequate monitoring, and a substantial healthcare burden.

METHODOLOGY:

• Researchers in Finland conducted an observational register-based study to assess the prevalence, clinical outcomes, treatment adherence, and healthcare resource utilisation among patients with diabetes.
• They identified 526,526 adults with diabetes (53% men) between January 2015 and September 2019, of whom 493,990 had type 2 diabetes (T2D); the median ages at baseline were 66 years for T2D and 39 years for type 1 diabetes (T1D).
• Adherence to testing for glycaemic control (A1c), kidney function (estimated glomerular filtration rate), and albuminuria (urine albumin-to-creatinine ratio) was calculated, and laboratory values were taken from tests performed within 12 months before or after baseline and within 18 months before the end of the nearly 7-year follow-up.
• Public all-cause and disease-specific healthcare resource use was estimated from national register data.
• Adherence and persistence to SGLT2 inhibitors were analysed from January 2017 to March 2022 using national prescription and purchase data.

TAKEAWAY:

• The prevalence of diabetes rose from 7.2% in 2012 to 9.9% in 2021; complications such as kidney disease, heart failure, and overall cardiovascular diagnoses with hospitalisations also increased during this period.
• At the end of follow-up, only 29% of patients with T1D achieved A1c levels ≤ 53 mmol/mol; 26% of those with T2D had an estimated glomerular filtration rate below 60 mL/min/1.73 m³, yet only 12% had a recorded diagnosis of chronic kidney disease.
• Patients averaged 41.2 healthcare contacts per year; however, in 2021, they completed a mean of 0.3 urine albumin-creatinine ratio tests per year. Factors associated with low test adherence were calendar year and higher A1c levels, whereas high test adherence was linked to older age, male sex, T2D, and worse kidney function.
• SGLT2 inhibitors were prescribed to 19% of patients; 29% discontinued within 1 year, and non-persistent users showed a trend towards higher rates of kidney complications and heart failure.

IN PRACTICE:

"[The study] data underline an urgent need for improved awareness and risk management in diabetes," the authors wrote.

SOURCE:

This study was led by Merja K. Laine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. It was published online on December 21, 2025, in Diabetes Research and Clinical Practice.

LIMITATIONS:

Albuminuria and kidney function were determined from single measurements. The assessment of comorbidities relied on diagnostic codes that were subject to underreporting bias. The analysis of SGLT2 inhibitor persistence did not account for concomitant medications.

DISCLOSURES:

This study was funded by Bayer Oy. Three authors reported being employees of the funding agency. Several authors reported receiving lecture fees, serving as advisory board members, and receiving consultancy fees from multiple companies and having other industry relationships; one author reported receiving lecture fees and being an advisory board member of Medscape.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.