New guidelines on treating people with diabetes and chronic kidney disease
A multiprofessional team, together with patient expert advice, has made a series of recommendations in a new comprehensive report designed to improve the treatment of people with advanced chronic kidney disease and diabetes.
The report, Standards of Care for Glycaemic Assessment in People with Diabetes on Haemodialysis, has been developed by the Association of British Clinical Diabetologists and the Renal Association.
It aims to provide healthcare professionals with expert advice on the complex area of glycaemic assessment in people with diabetes on haemodialysis. It examines the role of technological advancements, such as continuous glucose monitoring, in improving outcomes and quality of life in this important diabetes subgroup. The guidance provides practical advice on different methods of monitoring glycaemic control by using risk stratification in order to optimise therapy.
The team, made up of experts in diabetes and kidney care, worked with people with diabetes to produce 11 recommendations. In summary, the report states: “Briefly, HbA1c may not be a true reflection of prevailing glucose control in people with diabetes (PwD) on haemodialysis (HD) and does not provide sufficient information on glycaemic variability or hypoglycaemia risk. Given the increased risk of long-term poorer outcomes in this high-risk group, improved methods of glucose assessment are needed to adjust therapies to avoid hyperglycaemia, hypoglycaemia as well as improve time-in-range whilst minimising time-below- range to reduce the progression towards complications.”
The report’s lead authors are Dr Andrew Frankel, Consultant Nephrologist at Imperial College Healthcare NHS Trust and Dr Sufyan Hussain, Consultant Diabetes & Endocrine Physician at Guy’s & St Thomas’ NHS Trust.