Sun-129 Activation Levels Among Patients With comorbid Diabetes and Kidney Disease Attending a Co-Designed Integrated Model of Care: A longitudinal Study

Abstract

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.