{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:13:53Z","timestamp":1788444833749,"version":"build-2803163510"},"reference-count":52,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004515","name":"National University of Malaysia","doi-asserted-by":"crossref","award":["FF-2023-306"],"award-info":[{"award-number":["FF-2023-306"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,15]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Despite adherence to guideline-based pharmacotherapy, many people with diabetic kidney disease (DKD) were unable to meet glycaemic and blood pressure targets. The purpose of this paper was to report the unmet needs of people with early-stage DKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A sequential mixed-methods approach was used, comprising a quantitative survey followed by an exploratory qualitative phase using nominal group technique (NGT) discussions with people with DKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Patients were recruited from 45 primary care clinics in Peninsular Malaysia from March to May 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Survey data were collected from 131 adults with an estimated glomerular filtration rate between 30 and 89 mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      and with suboptimal glycaemia and blood pressure outcomes. Exploratory NGT discussions were conducted with seven participants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The online survey used the WHO definition of unmet healthcare need as the \u2018failure to seek healthcare when needed during the past twelve months\u2019 to assess the prevalence and associated factors. Qualitative data and ranking of other perceived unmet needs of these people with DKD and suboptimal clinical outcomes were collected through NGT discussions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of reported unmet healthcare needs per the WHO definition was 13%, with history of diabetic foot ulcer (adjusted OR (AOR) 6.67, 95%\u2009CI 1.22 to 37.25)\u2009and urban residence (AOR 3.70, 95%\u2009CI 1.26 to 12.89) reported as associated factors. NGT identified three patient-prioritised unmet needs: \u2018dietary support\u2019, \u2018better medication\u2019 and \u2018mental health support\u2019. Female participants prioritised obtaining medication and kidney health information, whereas male participants emphasised self-monitoring support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The low prevalence of WHO-defined unmet need, alongside patient-prioritised concerns extending beyond standard measures, suggests that current operational definitions may not fully capture patient-perceived unmet healthcare needs in DKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105861","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T17:50:24Z","timestamp":1780422624000},"page":"e105861","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-reported unmet healthcare needs among people with diabetic kidney disease in primary care in Peninsular Malaysia: a sequential mixed-methods study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-3623","authenticated-orcid":false,"given":"Soong Yiing","family":"Yap","sequence":"first","affiliation":[{"name":"Department of Public Health Medicine, National University of Malaysia Faculty of Medicine, Cheras, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamsul Azhar","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Public Health Medicine, National University of Malaysia Faculty of Medicine, Cheras, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subashini","family":"Ambigapathy","sequence":"additional","affiliation":[{"name":"Buntong Health Clinic, Ipoh, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"2026090306254536000_16.6.e105861.1","doi-asserted-by":"crossref","DOI":"10.1186\/s40842-015-0001-9","article-title":"Management of diabetes mellitus in patients with chronic kidney disease","volume":"1","author":"Hahr","year":"2015","journal-title":"Clin Diabetes Endocrinol"},{"key":"2026090306254536000_16.6.e105861.2","doi-asserted-by":"crossref","unstructured":"Pradeepa R , Mohan V . 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