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.
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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.
| Type: | Article |
|---|---|
| Title: | Closing the policy gap in diabetes care for individuals with advanced CKD |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/dme.15381 |
| Publisher version: | https://doi.org/10.1111/dme.15381 |
| Language: | English |
| Additional information: | © 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. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, diabetes model of care, integrated diabetes CKD care, joint diabetes CKD clinic |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10204742 |
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