EDITORIAL

Abstract

It has been a rewarding challenge to work with so many specialists from diabetic and renal health care teams bringing together what has been planned to be an interesting and helpful collection of articles discussing new treatments and reviews of practice. Throughout all the papers runs the theme that through the knowledge in this supplement, treatment can be improved and the burden of the two diseases may be lessened for the patient and financially for the health authorities. The topics in this supplement range from joint care planning to care at the end of life. Care pathways are described, demonstrating how important is combined care with consultants and other specialists – nurses, pharmacists, dietitians in the health care teams, collaborating to offer a focused programme of treatment for those with diabetic kidney disease. The epidemiology of kidney disease and diabetes is explored and it is shown how they overlap and together lead to, or are exacerbated by, cardiovascular disease. The message in this paper is how early diagnosis and correct treatment involving diabetes and renal specialists help decrease the rate of deterioration caused by the illness. The pharmaceutical information and advice given in the pharmacology paper demonstrates the necessity for the multi-professional teams to understand the complexities of both diseases to eliminate inappropriate and/or overlapping prescribing. These problems are also explored in the discussion on anaemia. Transplants and the extra problems created because of diabetic kidney disease are examined in several papers. One paper looks at the possibility of transplants and another details the after-care and problems which may occur, again increased knowledge about the possible complications may help decrease the likelihood of their occurrence. A further paper discusses transplants and the immigrant community especially those from Southern Asia, this highlights the problems which religion and culture can bring and which are exacerbated through lack of knowledge. Care of the diabetic foot is an area that is underexplored for the renal nurse; information and constructive advice for practice is provided in one paper and a second paper that offers scientific information on development of problems and outcomes of foot care. When read, one in conjunction with the other, they should provide useful scientific practical knowledge about care of the diabetic foot. Dietary information is vital as this is an area where overlapping and sometimes conflicting advice can be given. The confusion of advice is demonstrated in the paper discussing the process of adjusting to diagnosis, a psychological study giving a different view point to patients’ attitudes. This difficulty in adjusting might also explain the adverse reactions to suggestions of increased exercise in this population. Successfu pregnancy is a growing possibility for the kidney patient with diabetes, but there is still a great lack of knowledge about how both diseases can affect pregnancy; however this paper should highlight this lack and be a foundation for more research. Discussion on awareness about quality at the end of life is a fitting conclusion to this supplement. This supplement is a unique and informative collection of papers on diabetes and kidney disease where information about both diseases is brought together. It is published with the hope that, through more knowledge and understanding, patients and others concerned with caring for those with diabetic kidney disease will benefit. The author has no conflict of interest.