{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:42:10Z","timestamp":1784684530521,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2023,4,26]]},"abstract":"<jats:p>Background. Patients with comorbid type 2 diabetes mellitus (T2DM) and renal disease, particularly those treated with insulin, often require complex pharmacological treatment and management of other diabetes complications. Aims. To assess the achievement of metabolic targets and compare the current management of renal service attenders with insulin- and noninsulin-treated T2DM. Methods. Single-centre retrospective cross-sectional study involving medical record review of patients with T2DM aged \u226518 years who visited a metropolitan renal outpatient clinic in 2017. Univariable analysis and multivariable logistic regression were used to identify factors associated with insulin treatment. Results. Among 268 patients (45.5% insulin-treated), mean HbA1c was higher in insulin-treated vs. noninsulin-treated patients (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mn>8.0<\/a:mn>\n                        <a:mo>\u00b1<\/a:mo>\n                        <a:mn>1.8<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>% (64\u2009mmol\/mol) vs. <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mn>6.8<\/c:mn>\n                        <c:mo>\u00b1<\/c:mo>\n                        <c:mn>1.2<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>% (51\u2009mmol\/mol), <jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>). Significantly fewer insulin-treated patients had <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mtext>HbA<\/g:mtext>\n                        <g:mn>1<\/g:mn>\n                        <g:mtext>c<\/g:mtext>\n                        <g:mo>\u2264<\/g:mo>\n                        <g:mn>7.0<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>% (53\u2009mmol\/mol; 31.8% vs. 69.3%, <jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mi>p<\/i:mi>\n                        <i:mo>&lt;<\/i:mo>\n                        <i:mn>0.001<\/i:mn>\n                     <\/i:math>\n                  <\/jats:inline-formula>). More insulin-treated patients had ischaemic heart disease (46.7% vs. 33.6%, <jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mi>p<\/k:mi>\n                        <k:mo>=<\/k:mo>\n                        <k:mn>0.028<\/k:mn>\n                     <\/k:math>\n                  <\/jats:inline-formula>), diabetic foot disease (15.6% vs. 4.8%, <jats:inline-formula>\n                     <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\">\n                        <m:mi>p<\/m:mi>\n                        <m:mo>=<\/m:mo>\n                        <m:mn>0.003<\/m:mn>\n                     <\/m:math>\n                  <\/jats:inline-formula>), retinopathy (40.2% vs. 11.0%, <jats:inline-formula>\n                     <o:math xmlns:o=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\">\n                        <o:mi>p<\/o:mi>\n                        <o:mo>&lt;<\/o:mo>\n                        <o:mn>0.001<\/o:mn>\n                     <\/o:math>\n                  <\/jats:inline-formula>), and emergency attendance for severe hypoglycaemia (3.8% vs. 0% <jats:inline-formula>\n                     <q:math xmlns:q=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M9\">\n                        <q:mi>p<\/q:mi>\n                        <q:mo>=<\/q:mo>\n                        <q:mn>0.042<\/q:mn>\n                     <\/q:math>\n                  <\/jats:inline-formula>). Insulin treatment was more associated with chronic kidney disease stages 4-5 (adjusted odds ratio (aOR) 2.41, 95% CI 1.07-5.43), retinopathy (aOR 3.10, 95% CI 1.04-9.27), and podiatry review (aOR 5.06, 95% CI 1.20-21.38). Only 38 (14.2%) individuals were seen by a colocated public multidisciplinary diabetes service in 2017. Conclusions. Renal clinic attenders with T2DM, particularly if insulin-treated, remained at increased risk of diabetes-related complications, including severe hypoglycaemia, with limited input from the colocated hospital diabetes team. Approaches to increase coordination of diabetes care among renal patients should be investigated.<\/jats:p>","DOI":"10.1155\/2023\/1969145","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T19:20:10Z","timestamp":1682536810000},"page":"1-10","source":"Crossref","is-referenced-by-count":3,"title":["Diabetes Management and Outcomes among Patients with Type 2 Diabetes Attending a Renal Service"],"prefix":"10.1155","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8493-2969","authenticated-orcid":true,"given":"Elizabeth","family":"Skalkos","sequence":"first","affiliation":[{"name":"School of Medicine, Western Sydney University, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Rajagopal","sequence":"additional","affiliation":[{"name":"Macarthur Diabetes Service, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0560-0761","authenticated-orcid":true,"given":"David","family":"Simmons","sequence":"additional","affiliation":[{"name":"School of Medicine, Western Sydney University, Sydney, Australia"},{"name":"Macarthur Diabetes Service, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","volume-title":"Incidence of renal replacement therapy for end stage kidney disease","author":"Australia and New Zealand Dialysis and Transplant Registry","year":"2018"},{"issue":"5S","key":"2","first-page":"S1","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease","volume":"102","author":"Kidney Disease Improving Global Outcomes Diabetes Work Group","year":"2022","journal-title":"Kidney International"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-019-0837-x"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv101"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2016(01)08"},{"key":"6","volume-title":"Management of type 2 diabetes: a handbook for general practice","author":"The Royal Australian College of General Practitioners","year":"2020"},{"key":"7","volume-title":"Type 2 diabetes in adults: management","author":"National Institute for Health and Care Excellence","year":"2019"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-Sint"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4473-2"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0034"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2016.09.002"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-016-0120-z"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-016-0273-z"},{"key":"14","first-page":"1","article-title":"Prevalence of diabetes mellitus and risk factors in south western sydney: where are we now?","author":"U. 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