You may have not heard of it, but diabetic kidney disease (DKD) affects 50% of people who live with diabetes and there are 1.8 million people living with diabetes in Australia. You do the math. What is even more astounding is that 90% of kidney function can be lost without experiencing any symptoms.
If a person with diabetes has high blood sugar levels, the blood vessels throughout the body can become damaged over time, including in the kidneys which can lead to DKD. The likelihood of developing diabetes depends on the length of time since diagnosis, family history, age and ethnicity.
World Diabetes Day 2022 is an opportunity to shine a light on this important complication of Australia’s most common chronic condition.
A recent publication in Advances in Therapy by Nicholas et al. included interviews with three patients who provided their lived experience of type 2 diabetes and chronic kidney disease (CKD). The interviews demonstrated that understanding of CKD in patients with type 2 diabetes is improving, however, patients and clinicians still face challenges to access earlier diagnosis and treatment.
The publication concluded that shared decision-making between the patient and healthcare professional can improve the communication on this topic, especially for those with lower health literacy. It also recommended providing patients with educational resources earlier on in their CKD journey, rather than at end-stage kidney disease when little can be done to stop progression.
We spoke with Peter Said, Head of Patient Engagement at Bayer, APAC. The company has been actively involved in improving the lives of patients living with DKD and maintains close working relationships with local health consumer organisations. He said:
“DKD is actually a common and potentially deadly condition that is widely under-recognised, especially amongst patients with type 2 diabetes who are often burdened with dealing with the day-to-day management of their diabetes, as well as dealing with other aspects of their life. […]
“But unfortunately, DKD creeps in very early and brews away in the background. Hence why it’s such a silent killer. And when it’s noted, often a lot of the damage is already done.
“Knowledge is power and early prevention and detection is very important. […] Fortunately, simple tests can be performed by a general practitioner and can identify most cases of DKD when the disease is in its early stages, enabling treatment to prevent or slow progression and reduce the likelihood of developing kidney failure.”
Dialysis and kidney transplants are invasive and time-consuming treatment options. Dialysis limits a patient’s ability to work and their free time as they need to visit the hospital three times a week for five-hour sessions. For someone who is already diagnosed with DKD, the progression of their disease can be slowed down through lifestyle changes and treatment.
Treating DKD to slow down progression has been achieved with once-a-day therapies called SGLT2is and GLP1-RAs for some time. Last year a new type of therapy known as non-steroidal mineralocorticoid receptor antagonists (MRAs) was approved by the Therapeutic Goods Administration (TGA) for the treatment of DKD. Having a variety of therapy types available gives those patients who can no longer manage their DKD through lifestyle changes more choice and treatment options.
SGLT2is block the SGLT2 receptor which is responsible for 90% of reabsorption of glucose in the kidney. The non-steroidal MRAs block the mineralocorticoid receptor in cells of the kidneys, mineralocorticoid receptor overactivation is thought to contribute to kidney inflammation and fibrosis.
Mr Said commented: “For the past 20 years there’s been little in terms of innovation in chronic kidney disease and DKD therapy. Now, we have SGLT2is, GLP1-Ras and non-steroidal MRAs that have shown a benefit, so we are starting to make some real headway for patients with DKD.”
Mr Said concludes with the importance of industry and patient groups working together:
“Pharmaceutical companies can be really well placed to help coordinate a really diverse health ecosystem, with patient organisations, and patient advocates, a very important part of that.
“It’s no good coming up with a solution if it doesn’t resonate with patients. […] So, we’ve got a lot of work to do, but we need to do this as a collaboration and important patient partnerships are absolutely critical to our collective success.”
The theme of this year’s World Diabetes Day is “Access to Diabetes Care”. Read more on the World Diabetes Day website.
London Agency is a Melbourne-based healthcare communications and public relations agency.
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