OBJECTIVES

Considered as a major public health issue, chronic kidney disease (CKD) is an insidious and deleterious complication of diabetes, which is managed late in its evolution. In order to improve the management of type 2 diabetic patients (T2D) with CKD, knowledge of the care pathway in France of these patients and the qualification of the key issues and needs of each actor involved are essential elements, and yet still imprecise.

The objective of this analysis is to improve knowledge of the current care pathway for type 2 diabetic patients with chronic renal disease and to best qualify the key issues and needs of the various actors identified in this care pathway

METHODS

In order to have the most complete vision possible of the ecosystem in which the adult patient with type 2 diabetes and chronic kidney disease evolves, a review of the literature, supplemented by interviews with clinical experts (diabetologists, nephrologists, general practitioners, pharmacists, advanced practice nurses) were conducted as part of this research.

RESULTS

: The research carried out led to divide the care pathway of the T2D patient with CKD into five stages, in which different breaking points were identified. This care pathway is currently heterogeneous and unsuitable for the diabetic patient. Thus, the care teams and the French health authorities must define a comprehensive care pathway and strengthen support for these patients, in order to slow the progression of chronic kidney disease and reduce the use of renal replacement therapy. The experiments implemented today demonstrate the interest of institutions and health professionals in the care management of T2D patients with CKD and partially meet the needs and challenges identified.

CONCLUSIONS

: No experiments specific to care management of T2D patient developing CKD have been identified. Further efforts are now necessary to significantly improve the care pathway of these patients.