Diabetes and renal health are very important care and prescribing considerations for all prescribers and practice nurses. There has been a lot of new and revised information published during 2021 for health professionals about renal health, in particular relating to diabetes. New National Institute for Health and Care Excellent guidance (NICE, 2021a) for chronic kidney disease (CKD) and NICE (2021b) cardiovascular disease provide practitioners with the latest prescribing and treatment pathways for people at risk of these complications. Additional resources have recently been published by the UK Renal Association (2021a-c) about diabetes-related kidney disease and the GP Notebook (2021a) prescribing choices as well. This offers practitioners, especially practice nurses, wonderful resources to inform care approaches and safe prescribing.
PROTECT NOW
The iDEAL diabetes multi-disciplinary (MDT) advocacy group, following the success of ACT NOW, are aiming to reduce the number of preventable lower limb amputations by 50% in 5 years (Edmonds et al, 2020; Edmonds et al, 2021). ACT NOW has been endorsed by Diabetes UK, JDRF, IDF Europe, D-Foot International, Diabetes Research and Wellness Foundation, PCDS and the UK Diabetes Footcare Networks.
Following on from this initiative, iDEAL brought together leading experts in renal and diabetes health to design and create a series of information giving resources for people living with diabetes about their renal health. A gap was recognised in the accessibility and availability of such information for people with diabetes and their families, so the PROTECT NOW resources have been designed and created.
PROTECT NOW focuses on kidney disease and diabetes. This resource offers information and easy to understand evidence for people with diabetes, their families and also health professionals. Diabetes is the leading cause of kidney disease, with one in three adults with diabetes experiencing either declining renal function and chronic kidney disease (NICE, 2021a) or established proteinuria (UK Renal Association, 2021a). The prevention of this and sharing of information about how to protect kidneys is of vital importance for every person with diabetes.
iDEAL identified that a MDT approach with resources that are person facing in one easily accessible web place was the best and most efficient way to share understandable information and knowledge about diabetes and kidney health. PROTECT NOW is an acronym presented in Figure 1 and is underpinned by a person-centred approach (Language Matters, 2018).
Figure 1. PROTECT NOW
PROTECT NOW:
- P - provide education on what the kidneys do and what can happen when things go wrong
- R - regular review and early referral where appropriate
- O - optimising glucose, blood pressure and cholesterol management
- T - tests (estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR)): what they show and why they are important
- E - providing education and support
- C - coding and understanding each CKD stage
- T - choosing treatment options that protect the kidneys
- N - not being afraid to ask for information or support
- O - omitting certain medications during dehydrating illness using sick day guidance
- W - promoting individual health and well-being advice using person-centred care approaches.
PROTECT NOW is an accessible educational approach to reach people with diabetes and their families in a user friendly way and can be used in virtual diabetes care in both general practice (Diggle, 2020; Diggle and Brown, 2020) and specialist practice. Diabetes education in an easily accessible format for both health professionals and people living with diabetes (Phillips et al, 2019) is a pivotal way of breaking down barriers and sharing knowledge about diabetes care approaches.
Prescribing and renal health
Prescribing for people with diabetes is still not uniform across the UK, with some populations facing inequalities and restrictions in their treatment choices (Phillips, 2021). Using clinical guidance and easy to follow resources such as the GP Notebook Clinical Updates (2021a) can help to reduce such disparities and diabetes prescribing inequalities. Sick day advice for people with diabetes needs to be accessible and safe, especially regarding the prescribing of diabetes medications such as SGLT-2 inhibitors, sulphonylureas, GLP-1s and metformin. Non-diabetes medication to be stopped when people with diabetes are sick include NSAIDs, diuretics ARBs and ACE inhibitors (GP Notebook, 2021b). These are pivotal in protecting renal health, especially when individuals are unwell and have diabetes.
For renal health, having accessible knowledge easily to hand for people with diabetes and health care professionals can help to prevent renal damage from unfavourable prescribing choices or inappropriate sick day guidance (Stewart, 2021).
Conclusion
Reaching people with diabetes and health professionals with easy to access resources and information like PROTECT NOW offers increased knowledge sharing and information about diabetes and renal health to aim to protect both especially during times of sickness and ill health. PROTECT NOW can help guide practice nurse care and approaches, while sharing useful information and approaches with and for people with diabetes.