Introduction: While multi-disciplinary diabetes and renal clinics have been shown to improve surrogate clinical outcomes such as HbA1c and renal function decline, their impact on patient self-care is uncertain. We evaluated the impact of an integrated, person-centred diabetes and kidney disease clinic and model of care on diabetes self-care for patients with co-morbid diabetes and CKD. Methods: We conducted a longitudinal study of adult patients (over 18 years) with comorbid diabetes and CKD (Stage 3a or worse) attending a new co-designed diabetes and kidney disease service at a tertiary hospital. A questionnaire consisting of demographics, clinical data, and the Summary of Diabetes Self Care Activities (SDSCA) was administered at baseline and after 12 months. Paired t-tests were used to compare baseline and 12 month scores. Factors associated with change scores were examined by multiple regression analyses. Results: 179 patients, 63% of whom were male, with a baseline mean AE SD age of 66.0 AE11.3 years, were studied. Most had type 2 diabetes (97%) and moderate to advanced CKD (83% stages 3 to 4 CKD). Self-care significantly changed across the specific diet, exercising, blood sugar and foot checking subscales as well as the composite SDSCA score (all p<0.05). Factors associated with smaller changes in scores in the exercising subscale were older age and belonging to lower socioeconomic status (p<0.05). Factors associated with larger changes in scores in specific diet, exercising and blood sugar testing subscales were higher BMI, advanced CKD and drinking alcohol respectively (p<0.05). Conclusions: An integrated, person-centred diabetes and kidney disease clinic and model of care improved patients' diabetes self-care, an important component of complex multi-morbid chronic disease management.

In this incident cohort, ten years after CKD onset, percentages of patients dying in different CKD stages as well as those surviving to different CKD stages varied greatly by race/ethnicity. More Blacks and Hispanics progressed to advanced stages and ESKD than Whites, which resulted in more patients in these two groups surviving on dialysis as well as dying on dialysis than Whites. Novel research is needed to understand why more Blacks and Hispanics approached to advanced CKD stages and ESKD than Whites after CKD onset.