Long‐term outcomes of patients with type 2 diabetes attending a multidisciplinary diabetes kidney disease clinic

Low, Sui Pheng; Lim, Su Chi; Wang, Jiexun; Yeoh, Lee Ying; Liu, Yan Lun; Lim, Eng Kuang; Shao, Yan Li; Chui, Winnie; Fun, Sharon; Chua, Chin Lian; Tavintharan, Subramaniam; Sum, Chee Fang

doi:10.1111/1753-0407.12626

Cited by 11 publications

(14 citation statements)

References 25 publications

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“…Additionally, primary care professionals received positive feedback about the service from their patients and they also noted that some patients felt better. This could have been due to improvements in clinical outcomes such HbA1c and eGFR as reported previously [28].…”

Section: Discussionmentioning

confidence: 61%

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Zimbudzi

Robinson

et al. 2019

PLoS ONE

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Background To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service. Objective In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service. Methods 5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers. Results The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients. Conclusions Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.

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Section: Discussionmentioning

confidence: 61%

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Zimbudzi

Robinson

et al. 2019

PLoS ONE

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“…Of the 2177 unique citations identified in our literature search, 34 studies met inclusion. 12–45 The characteristics of included studies are noted in Table 1, and study outcomes and results are reported in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…There were 7 RCTs, 12,19,24,31,35,40,44 one cluster RCT, 15 19 observational cohort/case-control studies, 13,14,16,17,21–23,25–29,32,34,37–39,41,42,45 and 7 pre- and post-intervention studies included. 18,20,26,30,33,36,43 Studies were conducted in Australia, 44 Brazil, 32 Canada, 12,13,34,38 France, 36,37 Germany, 23 Hong Kong, 27 Japan, 22,28 Mexico, 26 the Netherlands, 24 New Zealand, 14,16,17 Singapore, 45 Sweden, 20 Thailand, 15 the United Kingdom, 18,21,30,33 and the United States. 19,25,29,31,…”

Section: Resultsmentioning

confidence: 99%

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Nonconventional diabetes-related care strategies for patients with chronic kidney disease: A scoping review of the literature

et al. 2019

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Background:Patients with diabetes and chronic kidney disease (CKD) are at high risk of diabetes-related complications. Diabetes care can support these individuals, but outpatient clinic appointments can be difficult to attend, given their already high burden of multimorbidity.Methods:We systematically searched the medical and grey literature for studies that evaluated the effect of nonconventional diabetes care strategies on diabetes-related outcomes in adults with stages 2–5 CKD or using dialysis (end of search December 30, 2017). We included both randomized-controlled trials and observational studies. Study selection and data extraction were completed by two independent reviewers. Diabetes-related outcomes included glycemic, blood pressure, and lipid control, along with microvascular complications, macrovascular complications, and death.Results:After screening 2177 relevant citations, we identified 34 studies which met inclusion. The majority were observational studies. Studies were frequently small, single-centered, and excluded patients with more advanced CKD. Nonconventional diabetes care strategies included community-based care, unique self-management and education programs, nurse-led care clinics, dialysis-based diabetes programs, telemedicine, and interdisciplinary care clinics. Programs were most often developed by study investigators. Although there were limitations to several of the included studies, programs were described to have modest effects on physiologic outcomes, and in some cases, diabetes-related complications and death.Conclusions:Nonconventional diabetes-related care might be helpful to patients with CKD. Prior to developing and implementing programs, however, it will be important to study them more rigorously, understand their acceptability to patients, and evaluate their costs and feasibility in a real-world setting.

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“…Data show that multidisciplinary endocrinology and nephrology care in the DKD clinic is associated with a lower risk of end-stage renal disease (ESRD) and improves outcomes. 4 Timely care of the kidney also helps in prevention of progression of chronic kidney disease. 5 A nephrology referral, therefore, helps in tertiary prevention of diabetes and secondary prevention of diabetes complications.…”

Section: Need For Referralmentioning

confidence: 99%

Nephrology Referral in Diabetes Practice

Kalra

Sahay

2018

Journal of Social Health and Diabetes

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Diabetic nephropathy, including diabetic kidney disease (DKD), is a major complication of diabetes. Appropriate management of DKD requires multispecialty intervention under the guidance of endocrinology and nephrology. However, delayed referral to specialized nephrology services usually occurs, and this leads to suboptimal outcomes. This multispecialty consensus suggests simple clinical and biochemical parameters that should prompt referral of DKD patients to nephrology. A checklist for physicians who manage DKD is also provided. AbstractKeywords ► chronic kidney disease ► diabetic kidney disease ► diabetic nephropathy ► end-stage renal disease ► type 1 diabetes ► type 2 diabetes

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Long‐term outcomes of patients with type 2 diabetes attending a multidisciplinary diabetes kidney disease clinic

Cited by 11 publications

References 25 publications

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Nonconventional diabetes-related care strategies for patients with chronic kidney disease: A scoping review of the literature

Nephrology Referral in Diabetes Practice

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