Determinants of primary healthcare physicians’ knowledge of diabetic kidney disease

Background: Early identification of diabetic kidney disease (DKD) is a real means to prevent the progression of kidney disease. The involvement of primary practitioners in screening programmes is particularly needed as most patients with diabetes are managed in primary care. Aim: This study aims to assess primary practitioners’ knowledge regarding screening, referral and management guidelines of patients with diabetes. Setting: Routine clinical setting in the region of Marrakesh. Methods: This was a cross-sectional study including primary practitioners in the region of Marrakesh between May and June 2024. A 16-item questionnaire was developed to evaluate their knowledge about screening, referral and management of DKD. Multivariate analysis was performed to identify factors associated with knowledge levels. Results: Of the 295 general practitioners solicited for the study, 100 physicians agreed to participate, thus translating to a response rate of 33.9%. Most participants (61%) showed high levels of adherence to DKD guidelines, but they presented a substantial gap in knowledge regarding the optimum screening time of DKD in patients with type 1 diabetes, the ideal screening test for albuminuria, the recommended interval for the routine surveillance, the annual screening tests, the therapeutic target of hemoglobin A1c (HbA1c), the indications of Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) and the timing of referral to a nephrologist. Higher knowledge scores were observed among physicians who received training in diabetes management. Conclusion: This study showed varying degrees of knowledge across different aspects of DKD management in primary care. Therefore, renal health programmes should prioritise enhancing the involvement and the regular training of primary practitioners. Contribution: This study emphasises the need for ongoing DKD training among primary healthcare practitioners to enhance their knowledge and improve the early management of patients with DKD.