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When it comes to effective diabetes patient care, health experts must look beyond the clinics and clinical trials.

It’s a revelation from research conducted by endocrinologist Dr. Kristin Clemens, which identified the socio-economic challenges confronting patients while managing their diabetes and advanced kidney disease.

“Many patients in our study came from lower-income backgrounds, so it can be difficult for them to pay transportation and parking costs for medical appointments,” says Clemens, a clinician-researcher at St. Joseph’s Health Care in London, Ont. “It can also be challenging to take time out of their workday to see specialists for their various health conditions.”

Researchers have made significant strides in improving quality of life for people with diabetes. New medications and technologies—like insulin pens that connect directly to smartphones—have made self-guided disease management easier for these patients. But research has historically focused on treatments for patients in the earlier stages of diabetes, and fewer studies address best practices for those with later-stage diabetes living with multiple health complications. These comorbidities typically exclude patients from clinical trials and research studies, limiting foundational research for this patient population.

Aiming to change that dynamic, Clemens has focused her research on diabetes patients with comorbidities, or additional medical conditions, including advanced kidney diseases.

Clemens recently examined diabetes care in a population-based study of more than 4,000 Ontarians withdiabetes undergoing dialysis treatment for kidney disease. Over a two-year period, the study found 40 per cent of patients experienced a gap in their diabetes care, a disconnect between best practices and their actual quality of care.

Her team then conducted a qualitative, patient-oriented study to uncover the factors contributing to those gaps. This work revealed several unique challenges patients faced while managing diabetes and advanced kidney disease. The cost of transportation and parking, and taking time away from work are factors that are preventing patients from accessing diabetes care. Many patients also voiced a desire for professional help in coordinating their diabetes care.

Building on these insights, Clemens’ team implemented a diabetes outreach program in the dialysis unit at London Health Sciences Centre’s Kidney Care Centre, with financial support from the St. Joseph’s Health Care Foundation. Led by a diabetes educator, the program offers health management assistance to patients with diabetes while they receive dialysis treatment. The educator helps patients stay on schedule with insulin shots and other medications. They also remind patients to have screenings conducted in optometry and podiatrist units to help prevent impaired vision and foot ulcers that may result from increased blood sugar.

To ensure consistent care, the educator communicates regularly with the patient’s nephrologists, family doctors and endocrinologists. Clemens says the program has improved the patients’ self-management skills, blood sugar levels and overall satisfaction with their level of care.

Clemens hopes her team’s research will support similar programs for patients living with diabetes and comorbidities.

“Before we pour our dollars into clinical trials, it’s essential to understand what matters to patients,” she affirms. “Through this work, I’ve developed an even deeper understanding of what my patients experience on a daily basis, and that has transformed how I practice as a physician. I hope this research helps emphasize the importance of patient-centered efforts to improve the health and quality of life of all patients with diabetes.”