{
  "abstract": "Background\n\nRenin-angiotensin system inhibitors (RASi) are recommended as first-line therapy for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), particularly in the presence of hypertension or albuminuria. This study assessed the treatment patterns in a cohort of high-risk T2D patients.Methods\n\nThis cross-sectional, retrospective study included 33,524 adults with T2D from the Imperial College London Diabetes Centre (United Arab Emirates). Demographic, clinical, and laboratory parameters (estimated glomerular filtration rate, urine albumin-to-creatinine ratio, and blood pressure (BP)), and medication usage were analysed. The primary outcome was the analysis of treatment patterns in patients undergoing RASi; secondary outcomes included prescribing trends in CKD risk categories and among hypertensive and albuminuric subgroups.Results\n\nAmong 33,524 patients with T2D, mean age was 59.2 years, BMI 29.4 kg/m², and 67.1% (n=22,508) of the patients were classified as KDIGO (Kidney Disease: Improving Global Outcomes) G1 and 73.3% (n=24,580) as A1 albuminuria. Overall, 35.3% (n=13,705) received RASi, while 64.7% (n=25,128) were treated with alternative therapies including SGLT2 inhibitors, GLP-1 receptor agonists, or finerenone. Among patients with albuminuria >3.5 mg/mmol, only 62% (n=4944) were prescribed RASi, despite meeting clear indications for treatment. In KDIGO-based risk stratification, only 39% (n=4406) of patients in the high and very high CKD progression risk categories were on RASi. Among the hypertensive subgroup (n=4,824; defined as BP >130/80 mmHg), 48.96% (n=2,362) were prescribed RASi, leaving over 50% of patients untreated with this guideline-recommended therapy. Furthermore, 7.46% (n=2,462) of the entire cohort had hypertension but were not receiving RASi. This gap was more prominent among those with coexisting albuminuria or CKD. These findings reflect under-treatment even among those at greatest risk of renal and cardiovascular events.Conclusion\n\nIn patients with T2D and established renal or cardiovascular risk, treatment patterns remain variable in real-world practice. Less than half of hypertensive or albuminuric patients received RASi, highlighting a significant implementation gap. Addressing barriers to RASi prescription is essential to align real-world clinical practice with international guidelines and improve patient outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nephrology, King's College Hospital London, Dubai, ARE.",
    "Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, ARE.",
    "Faculty of Medicine, Pavol Jozef Šafárik University, Košice, SVK.",
    "Faculty of Medicine, Andrzej Frycz Modrzewski Krakow University, Krakow, POL.",
    "Department of Emergency Medicine, University College London Hospitals NHS Foundation Trust, London, GBR."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Mustafa J Ahmed"
    },
    {
      "affs": [
        1
      ],
      "name": "Aftab M Ahmad"
    },
    {
      "affs": [
        1
      ],
      "name": "Saf Naqvi"
    },
    {
      "affs": [
        2
      ],
      "name": "Khalid Ahmed"
    },
    {
      "affs": [
        3
      ],
      "name": "Aisha Ahmed"
    },
    {
      "affs": [
        4
      ],
      "name": "Zainab Naqvi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f1d0tfcf12fsf.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.116699",
  "fulltext_url": "https://europepmc.org/articles/PMC13688004",
  "id": "f1d0tfcf12fsf",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42923248",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Renin-Angiotensin System Studies"
    ]
  ],
  "openalex": "W7213977779",
  "pdf_url": "https://europepmc.org/articles/PMC13688004?pdf=render",
  "pmcid": "PMC13688004",
  "pmid": "42923248",
  "published": "2026-09-22",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/f1d0tfcf12fsf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:02Z",
      "native_id": "MED:42923248",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42923248"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Renin-Angiotensin System Studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Renin-Angiotensin System (RAS) Inhibitors in High-Risk Patients With Type 2 Diabetes and Cardio-Renal Risk.",
  "title_text": "Renin-Angiotensin System (RAS) Inhibitors in High-Risk Patients With Type 2 Diabetes and Cardio-Renal Risk.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:02Z",
  "url": "https://research.draconitic.com/paper/f1d0tfcf12fsf",
  "venue": "Cureus",
  "versions": []
}