eprintid: 10204742 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/20/47/42 datestamp: 2025-02-14 09:50:45 lastmod: 2025-02-14 09:50:45 status_changed: 2025-02-14 09:50:45 type: article metadata_visibility: show sword_depositor: 699 creators_name: Habte-Asres, Hellena Hailu creators_name: Rosenthal, Miranda creators_name: Nitsch, Dorothea creators_name: Wheeler, David C title: Closing the policy gap in diabetes care for individuals with advanced CKD ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: G93 keywords: Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, diabetes model of care, integrated diabetes CKD care, joint diabetes CKD clinic note: © 2024 The Author(s). Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. abstract: Aim: The co-existence of diabetes and CKD poses significant challenges to healthcare systems, current frameworks often inadequately address the complex needs of individuals with both conditions. Recognising these gaps, we introduced a new diabetes care model for people with advanced CKD in renal satellite units.This paper aims to evaluate this new diabetes model care. Method: We conducted a prospective audit of a new integrated diabetes kidney care model. Data were presented as mean ± SD or counts/percentages, and pre- and post-intervention differences were assessed using paired samples t-tests. Results: A total of 291 individuals with diabetes and advanced CKD stages 4 or 5, or undergoing haemodialysis, were included. The mean age was 68.5 (±13.0) years, 58.4% were males. Nearly half of the cohort had four or more long-term conditions, while two-thirds experienced mild/severe frailty. Only 6% were receiving ongoing diabetes care from secondary care diabetes specialist services. For patients with CKD not receiving dialysis, comparing pre- and post-intervention, there were improvements in HbA1c (−13.0 mmol/mol, p < 0.001), SBP (−13.7 mm Hg, p < 0.0001), and weight (−2.9 kg, p < 0.0001). Furthermore, there was an increase in guideline-directed therapies, with notable usage of SGLT2i (62.9%) and GLP1-RA (28.4%), while access to diabetes technology increased to 89%. Conclusion: This new model of care resulted in improved metabolic outcomes, increased utilisation of guideline-directed therapies, and enhanced access to diabetes technologies. However, the model also revealed significant unmet clinical needs in areas such as access to diabetes care, diabetes eye screening and foot surveillance. date: 2025-02-01 date_type: published publisher: WILEY official_url: https://doi.org/10.1111/dme.15381 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2286937 doi: 10.1111/dme.15381 medium: Print-Electronic lyricists_name: Wheeler, David lyricists_id: DWHEE12 actors_name: Wheeler, David actors_id: DWHEE12 actors_role: owner funding_acknowledgements: [AstraZeneca (AZ)]; [Royal Free London] full_text_status: public publication: Diabetic Medicine volume: 42 number: 2 article_number: e15381 pages: 9 event_location: England issn: 0742-3071 citation: Habte-Asres, Hellena Hailu; Rosenthal, Miranda; Nitsch, Dorothea; Wheeler, David C; (2025) Closing the policy gap in diabetes care for individuals with advanced CKD. Diabetic Medicine , 42 (2) , Article e15381. 10.1111/dme.15381 <https://doi.org/10.1111/dme.15381>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10204742/1/Closing%20the%20policy%20gap%20in%20diabetes%20care%20for%20individuals%20with%20advanced%20CKD.pdf