Diabetes and renal disease: who does what?

Area of Science:

• Nephrology
• Diabetology
• Public Health

Background:

• Diabetes and chronic kidney disease (CKD) care in the UK involves primary care, diabetologists, and nephrologists.
• Current care distribution models for these patients are not well understood.

Purpose of the Study:

• To analyze the distribution of care provision for patients with diabetes and CKD in the UK.
• To identify potential disparities in referral patterns and care management.

Main Methods:

• Retrospective analysis of patient care data.
• Examination of patient distribution across primary care, diabetology, and nephrology services.
• Assessment of renal function decline (eGFR) in different care cohorts.

Main Results:

• Nephrology services manage a minority of diabetic CKD patients, primarily those with eGFR <30 ml/min.
• 70% of patients in nephrology showed no progressive renal dysfunction.
• Half of patients managed in primary care or diabetology without nephrology input had eGFR decline >5 ml/min/yr.

Conclusions:

• Older age may deter nephrology referral, leading to under-referral of progressive CKD cases.
• Nephrology services see a significant proportion of stable CKD patients, while progressive cases may be under-managed.
• Current care models may not optimally allocate resources for patients with diabetes and CKD.