Attending an integrated nephrology and diabetology outpatient service can improve diabetic kidney disease treatment: a single-center experience

Background: Glucose-lowering medications with established reno-protective effects are still underused in Italy. We explored whether attending an integrated nephrology and diabetology (NPD) outpatient service can improve clinical outcomes and adherence to treatment guidelines for diabetic kidney disease (DKD). Methods: We retrospectively included 110 DKD patients (aged 71.1 ± 10.1 years; 74.5% males) having attended the NPD outpatient service of CTO Hospital (Rome) between June and November 2023. Age- and gender-matched control group included DKD patients attending regular Diabetology outpatient service. Drugs prescriptions, clinical and biochemical parameters related to routine evaluation of DKD were collected at first and 6-months control visit. Results: This DKD population was made of 28.2% of patients with urine albumin-creatinine ratio (UACR) > 30 mg/gr, 33.6% with glomerular filtration rate (GFR) < 60 ml/min, 38.2% with both abnormalities. Proportion of patients prescribed with most recent anti-diabetic medications significantly increased after attending the NPD service (for SGLT-2 inhibitors, 54.5 vs. 25.5%, p < 0.01; for GLP1-R agonists, 28.3 vs. 21.8%, p = 0.01), as well as for statins (p < 0.01) and calcium channel-blockers (p = 0.01). During the same observation period we registered significant reduction in LDL cholesterol (p = 0.01) and UACR levels (p = 0.007), with a trend toward improvement in HbA1c and eGFR. Conversely, no significant differences in drugs prescriptions were reported in the control group, except for SGLT-2 inhibitors. Conclusions: Enhanced real-time interaction and collaborative decision-making in an outpatient setting that integrates both diabetology and nephrology expertise can lead to better clinical outcomes and greater adherence to DKD management guidelines, ultimately providing a more comprehensive strategy for cardio-renal risk reduction.