Closing the Awareness Gap: The Diabetes and Kidney Disease Relationship

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Olga Sinigaglia, clinical dietician and community educator, speaks to participants at the Morovis Community Health Center in Puerto Rico.
Olga Sinigaglia, clinical dietician and community educator, spoke to participants at the Morovis Community Health Center in Puerto Rico

Approximately one-quarter of the nearly 30 million American adults with diabetes have chronic kidney disease (CKD) — kidney damage or decreased kidney function that becomes life-threatening over time. 

Two Centers for Medicare & Medicaid Services Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) spotted an opportunity to leverage their ongoing work in diabetes self-management education (DSME) to create awareness of CKD, improve screening rates and reduce the progression of the disease. 

The TMF Quality Innovation Network, the QIN-QIO serving Arkansas, Missouri, Oklahoma, Puerto Rico and Texas, and Atlantic Quality Innovation Network (AQIN), the QIN-QIO serving New York, South Carolina and Washington, D.C., are pioneering this intersection of educational resources and strategies for diabetes and CKD self-management. They’re working under the guidance of Dr. Edwin Huff, science officer/​contracting officer for the Special Innovation Project.

Their biggest barrier? Getting the information out there to patients who don’t realize how closely diabetes and CKD are related,” said Janice Hidalgo, director of IPRO, the non-profit organization leading AQIN. 

The TMF QIN teamed up with national partners, including the National Kidney Foundation and the American Kidney Fund, to align subject-matter experts and tools, and recruited practices already partnering on the Everyone with Diabetes Counts (EDC) program to target people with diabetes and hypertension. They are now focused on certifying community DSME educators as kidney health coaches and offering expanded online education and screening for Kidney Health Month.

IPRO focused their work on creating and implementing the program for vulnerable populations in New York. They partnered with community-based organizations working on DSME to create a four-week curriculum. The goal was to graduate 1,000 beneficiaries by August 2019 with 80 percent demonstrating better awareness of the disease. The most significant focus for them was to see improvement in understanding of the intersection of CKD, diabetes and hypertension, and to increase screening rates for CKD. 

We found that once people learn and understand that managing diabetes and hypertension could mean a reduced risk of CKD, they’re pretty much invested in learning more,” said Hidalgo.

So far, TMF has recruited 128 providers in Arkansas, Missouri, Oklahoma and Texas, 474-plus kidney health coaches and 1,307-plus trained beneficiaries. TMF has also seen a 38 percent improvement rate in the understanding of the relationship between CKD and diabetes among their graduates. 

IPRO has graduated 832 of their 1,000-beneficiary goal with six months left in the project, and has seen improvement in CKD knowledge for 89 percent of their graduates.

For Preetha Prithivathi, director of quality improvement at TMF, the project hits close to home. I have family members with diabetes who have passed due to kidney failure. We didn’t know about CKD until I started with this project, so awareness that with treatment and lifestyle changes you can help slow or stop your kidney disease from getting worse is a huge gap,” Prithivathi said.

Hidalgo noted that in New York the work directly helps minority communities experiencing disparities in their health care, including black and Hispanic populations, who have the highest rates of diabetes and hypertension. Seeing people in awe during the workshops just warms my heart. They’re thinking about how what we’re sharing with them could help improve their life or the life of their loved ones.” 

TMF and IPRO hope patients will become more empowered to request CKD screenings from their providers and understand the importance of self-management of their disease. The QIN-QIOs also hope to encourage other organizations to initiate these types of educational programs across the country.

The success of this project thus far validates that community education works,” Hidalgo said. When you have beneficiaries not only learn about the disease but also how to manage it holistically, behavior change is just going to happen.”