[Therapy of chronic metabolic acidosis among diabetologist]

Chronic metabolic acidosis (CMA) is a common complication of chronic kidney disease (CKD). Its treatment in patients with diabetes mellitus and CKD could also improve insulin resistance. We investigated the current therapeutic approaches in diabetes mellitus (DM) with CKD in a survey among diabetologic specialists and general practitioners with additional qualification in diabetology about their approach to CMA and cooperation with nephrologists.

5863 practitioners were invited to complete a 27 item survey. 97 completed surveys were analysed descriptively.

Most participants were internists with additional qualification in diabetology (46 %). They cared for median 50 (10; 112) patients with DM type I and 210 (100; 450) patients with diabetes m, type II per quarter. CMA was observed by 12 % of practitioners during the last 12 months in median 4 (2; 6) patients with DM type I and 10 (3; 30) with type II. CMA was mainly diagnosed via serum bicarbonate (28 %) or base excess (20 %). 39 % received a recommendation from the nephrologic colleagues about treatment of CMA. About one third of diabetologists rated this recommendation as highly relevant (29 %) and feasible (27 %). For treatment of CMA, oral bicarbonate is preferred (39 %). Most participants preferred their nephrological colleagues doing specialist diagnostics (90 %) including blood gas analysis, as well as taking care of the treatment of CMA (62 %) and anemia (53 %). 34 % had not treated CMA in their practice so far. The cooperation between the participants and nephrologists was evaluated good (81 %). Most participants (78 %) would appreciate further education with a focus on CMA.

Cooperation between diabetologists and nephrologists works well. Nephrologists are mainly responsible for diagnosis and treatment of CMA. However, because CMA may worsen insulin resistance, its relevance for DM treatment appears to be underestimated. Further education may be required in this field.