Low Rates of Kidney Disease Monitoring among Patients with Diabetes and A Lack of Association with Language...

To describe kidney health evaluation rates in patients with type 2 diabetes mellitus overall and compare outcomes by language preference.

Retrospective cohort analysis.

Adult patients with type 2 diabetes mellitus who had primary care visits between January 2021 and December 2022 at a large academic medical center with 15 primary care clinics in Boston, MA.  EXPOSURE(S)/PREDICTOR(S): Language preference as documented in the electronic health record, categorized as non-English language preference or English language preference.  OUTCOME(S): The primary outcome was evaluation of the Kidney Health Evaluation for Patients with Diabetes (KED) measure, defined as receiving both estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) tests during 2023. The secondary outcome was cystatin C evaluation.

Generalized estimating equation logistic regression with clustering by primary care provider was used for adjusted analyses, controlling for patient demographics, clinical factors, medication use, and healthcare utilization. Stratified analyses examined outcomes by CKD severity, insurance status, and primary care engagement.

Overall, 88% of patients received eGFR evaluation, 57% received uACR evaluation, 56% achieved KED evaluation, and only 5.3% received cystatin C evaluation. Overall, there were no significant differences between NELP and ELP patients in any kidney health evaluation. However, stratified analyses revealed among patients with frequent engagement (≥ 4 visits), NELP patients received significantly more comprehensive screening than ELP patients (69% vs 64%, adjusted OR 1.22, 95% CI 1.01-1.48, p = 0.04).

Single-site study limiting generalizability. Electronic health record language preference may not reflect proficiency or language concordance.

While only half of patients received recommended kidney evaluation, language-based disparities were absent overall and reversed among highly engaged patients. These findings suggest misalignment between process measures and known downstream disparities in clinical outcomes. Our findings indicate missed opportunities for earlier detection and management of kidney disease.