Learning Collaborative: Diabetes & CKD
Chronic kidney disease (CKD) is a common and serious comorbidity among individuals with diabetes and is often underdiagnosed. Why is this a priority?
Diabetes is the leading cause of CKD in the United States (US).
CKD is an independent risk factor for cardiovascular events and death in people with diabetes.
People living with comorbid kidney disease with their diabetes have amplified risk for a cardiovascular event and that often proves lethal before they even reach kidney failure and the need for dialysis.
Data also show that earlier markers of kidney injury—such as reduced eGFR, hyperfiltration, and elevated urinary inflammatory biomarkers—are more commonly identified in communities facing barriers to specialty access and preventive care.
Medically underserved populations with diabetes have a higher prevalence and risk to develop CKD but they are less likely to be diagnosed with CKD.
Certain populations experience higher prevalence and faster progression of CKD:
Earlier intervention opportunities are frequently missed, as many individuals in rural and medically underserved communities receive limited kidney-specific care before progression to kidney failure.
To address these gaps in care, EDAN launched a dedicated collaborative of three regional ECHO hub teams to develop programming focused on improving diabetes-related CKD detection, risk stratification, and management in rural and medically underserved communities.
goals of the collaborative:
Leverage the Project ECHO® (Extension for Community Healthcare Outcomes) model to expand the capacity of community health centers and primary care practices to deliver high-quality care for individuals with diabetes-related chronic kidney disease (CKD), particularly in rural and medically underserved communities.
Strengthen the ability of primary care clinicians to screen, diagnose, risk-stratify, and manage CKD associated with diabetes using guideline-directed therapy.
Increase awareness of the importance of early CKD detection and consistent screening in communities with limited specialty access.
Develop durable tools, curricula, and implementation resources toto support replication and sustainable expansion of diabetes-related CKD ECHO programming.
Diabetes & CKD Learning Collaborative
EDAN assembled and funded the first Project ECHO learning collaborative designed to implement diabetes-focused ECHO programming with shared guiding principles and priority areas.
EDAN issued a competitive RFP to established U.S.-based ECHO hubs with proven infrastructure and the administrative capacity to launch new diabetes-related ECHO programs within 6–12 months (programs launched September 2022–January 2023). Priority was given to hubs demonstrating strong community partnerships and outreach to “spoke” sites serving rural, safety-net, and community-based settings (e.g., FQHCs and FQHC look-alikes), as well as engagement with managed care organizations and/or state Medicaid agencies.
EDAN awarded funding to three ECHO hubs—University of Washington, Rutgers (The State University of New Jersey), and University of Colorado—to establish regional ECHO programs focused on diabetes and CKD. These teams implemented programs consisting of 8–18 sessions. The collaborative reached 582 total participants, including 251 unique learners, with an average session attendance of 28 participants.
Collaborative members engaged in structured best-practice and resource sharing, including twice-monthly one-hour virtual meetings. Participants developed shared didactic topics, learning objectives, and case-based content to promote consistency and quality across sites.
A shared outcomes assessment framework was developed in collaboration with participating hubs, incorporating measures of prescribing patterns, clinical knowledge, confidence, and self-efficacy. Aggregated results demonstrated improvements in primary care clinician knowledge, confidence, and practice patterns, confirming the feasibility of coordinated multi-site learner evaluation.
Collaborative members also contributed to the development of an implementation toolkit to support integration of diabetes-related CKD curricula into existing ECHO programs. The toolkit was also developed into an interactive training module to facilitate broader dissemination and replication and is available HERE.