Chronic kidney disease (CKD) is a common occurrence in patients with diabetes mellitus (DM), occurring in approximately 40% of cases. DM is also an important risk factor for cardiovascular disease (CVD), but CKD is an important mediator of this risk. Multiple CVD outcomes trials have revealed a greater risk for CVD events in patients with diabetes with CKD versus those without. Thus, reducing the risk of CKD in diabetes should result in improved CVD outcomes. To date, of blood pressure (BP) control, glycemic control, and inhibition of the renin-angiotensin system (RASI), glycemic control appears to have the best evidence for preventing CKD development. In established CKD, especially with albuminuria, RASI slows the progression of CKD. More recently, sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP1RA) have revolutionized the care of patients with diabetes with and without CKD. SGLT2i and GLP1RA have proven to reduce mortality, heart failure (HF) hospitalizations, and worsening CKD in patients with diabetes with and without existing CKD. The future of limiting CVD in diabetes and CKD is promising, and more evidence is forthcoming regarding combinations of evidence-based therapies to further minimize CVD events.

Background: While obesity is a chronic condition that predisposes patients to other more serious disorders, the prevalence and the documentation of obesity as diagnosis has not been extensively studied in hospitalized patients. We conducted a retrospective chart review to investigate the prevalence and documentation of obesity as a diagnosis among patients admitted to our medical center. Method: IRB approval was obtained for this retrospective study. Body mass index (BMI) as per CDC, admission and discharge diagnosis of obesity and common comorbidities (hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive heart disease, chronic kidney disease and chronic obstructive pulmonary disease) were recorded. The length of stay in the hospital was also calculated. We also investigated whether counselling was provided to the obese patients for weight loss. Results: A total of 540 consecutive patients were reviewed with a mean age was 66 ± 6 years. Out of 540 patients only 182 (34%) had normal weight, 188 (35%) of the patients were overweight and 170 (31%) patients were obese. Of the obese group, 55% were female and 45% were male.100 (59%) had class I obesity, 43 (25%) had class II obesity and 27 (16%) class III obesity. Of the obese patients 40/170 (23.5%) patients had obesity documented on the admission problem list and only 21 (12%) had obesity documented as a discharge diagnosis. Only 3 (2%) patients were given appropriate counseling and referral for obesity management during the hospitalization. Comorbidities and their prevalence included, hypertension (68%), diabetes mellitus (35%), hyperlipidemia (36%), coronary artery disease (18%), chronic kidney disease (17%), congestive heart failure (18%) and COPD (24%). The average length of stay in normal weight, overweight and obese patients was similar for all three groups (4.5 ± 0.5 days). Conclusion: A significant number of hospitalized patients were overweight and obese. An overwhelming percentage never had weight status documented. Hospitalization offers health care providers a window of opportunity to identify obesity, communicate risks, and initiate weight management interventions.