Habte-Asres Hellena Hailu, Rosenthal Miranda, Nitsch Dorothea, Wheeler David C
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Royal Free London, NHS Foundation Trust, London, UK.
Diabet Med. 2025 Feb;42(2):e15381. doi: 10.1111/dme.15381. Epub 2024 Jun 10.
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.
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.
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%.
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.
糖尿病与慢性肾脏病（CKD）并存给医疗保健系统带来了重大挑战，当前的框架往往无法充分满足同时患有这两种疾病的个体的复杂需求。认识到这些差距后，我们在肾脏卫星单位为晚期CKD患者引入了一种新的糖尿病护理模式。本文旨在评估这种新的糖尿病护理模式。
我们对一种新的综合糖尿病肾脏护理模式进行了前瞻性审计。数据以均值±标准差或计数/百分比表示，并使用配对样本t检验评估干预前后的差异。
共纳入291例患有糖尿病且处于CKD 4期或5期、或正在接受血液透析的患者。平均年龄为68.5（±13.0）岁，58.4%为男性。近一半的队列有四种或更多的长期疾病，而三分之二的人有轻度/重度虚弱。只有6%的患者接受二级护理糖尿病专科服务的持续糖尿病护理。对于未接受透析的CKD患者，比较干预前后，糖化血红蛋白（HbA1c）有所改善（-13.0 mmol/mol，p<0.001），收缩压（SBP）有所改善（-13.7 mmHg，p<0.0001），体重有所改善（-2.9 kg，p<0.0001）。此外，指南指导的治疗有所增加，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的使用率显著提高（62.9%），胰高血糖素样肽1受体激动剂（GLP1-RA）的使用率为28.4%，同时糖尿病技术的使用增加到89%。
这种新的护理模式改善了代谢结果，增加了指南指导治疗的使用，并提高了糖尿病技术的可及性。然而，该模式还揭示了在糖尿病护理、糖尿病眼部筛查和足部监测等领域存在重大未满足的临床需求。
