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Audit within Brooklands and Northenden Primary Care Network revealed that people with type 2 diabetes under the age of 50 years were an underserved population and were less likely to receive the recommended eight care processes than other age groups locally. This article outlines the initiatives carried out to address this inequality. The work involved a Diabetes Support Team (DiaST) model of care and embedded an array of actions to overcome barriers to engagement among this hardly reached group. The initiative has resulted in more than a doubling of the rate of care process achievement in this population, although disparities with other age groups remain. The article should serve as inspiration for services looking to make the most of NHS England's T2Day (Type 2 Diabetes in the Young) programme to fund extended health checks for people aged 18-39 years living with type 2 diabetes. [ABSTRACT FROM AUTHOR]

CoDES (COmmunity Diabetes Education and Support) was established in April 2018 as a pilot project to integrate type 2 diabetes care between primary, secondary and community services in Central Manchester, historically an area with poor diabetes and cardiovascular outcomes despite a high spend. Two years on, it has succeeded in this integration and has promoted holistic primary care diabetes management, delivered education to over 1750 healthcare professionals and has supported people with diabetes, their families and carers throughout their diabetes journeys. This article describes the setup and practices of CoDES and the outcomes of the project over the two-year pilot. [ABSTRACT FROM AUTHOR]

Diabetic kidney disease (DKD) is a topic of increasing concern among clinicians involved in the management of type 2 diabetes mellitus (T2DM). It is a progressive and costly complication associated with increased risk of adverse cardiovascular (CV) and renal outcomes and mortality. Ongoing monitoring of the estimated glomerular filtration (eGFR) rate alongside the urine albumin:creatinine ratio (ACR) is recommended during regular T2DM reviews to enable a prompt DKD diagnosis or to assess disease progression, providing an understanding of adverse risk for each individual. Many people with DKD will progress to end-stage kidney disease (ESKD), requiring renal replacement therapy (RRT), typically haemodialysis or kidney transplantation. A range of lifestyle and pharmacological interventions is recommended to help lower CV risk, slow the advancement of DKD and prevent or delay the need for RRT. Emerging evidence concerning sodium-glucose co-transporter-2 inhibitor (SGLT2i) agents suggests a role for these medicines in slowing eGFR decline, enabling regression of albuminuria and reducing progression to ESKD. Improvements in renal end points observed in SGLT2i CV outcome trials (CVOTs) highlighted the possible impact of these agents in the management of DKD. Data from the canagliflozin CREDENCE trial (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) have since demonstrated the effectiveness of this medicine in reducing the risk of kidney failure and CV events in a population comprising individuals with T2DM and renal disease. CREDENCE was the first SGLT2i study to examine renal outcomes as the primary end point. Real-world studies have reaffirmed these outcomes in routine clinical practice. This article summarises the evidence regarding the use of SGLT2i medicines in slowing the progression of DKD and examines the possible mechanisms underpinning the renoprotective effects of these agents. The relevant national and international guidance for monitoring and treatment of DKD is also highlighted to help clinicians working to support this vulnerable group. [ABSTRACT FROM AUTHOR]

If treated suboptimally, type 2 diabetes can have devastating long-term complications, including cardiovascular disease, renal disease and blindness; however, such complications can be prevented with early effective diabetes engagement and management. A crucial part of diabetes care is the clinical review, which ideally each person with type 2 diabetes should undergo at least annually. Often this annual review is undertaken by more generalist rather than diabetes specialist healthcare professionals. This article is a guide to the basics that healthcare professionals should be aware of to effectively review a person with type 2 diabetes, related to the 15 healthcare essentials advocated by Diabetes UK. First published in 2019, this article has undergone an update at the end of 2020 to keep pace with recent guidance and resource publications, and to reflect changes in working practices in light of the COVID-19 pandemic. Useful resources for both healthcare professionals and individuals with type 2 diabetes are signposted throughout the article to facilitate enhanced learning. [ABSTRACT FROM AUTHOR]

Management of hypertension is a cornerstone of diabetes management. In August 2019, NICE published updated guidance on the management of hypertension both in people without diabetes and, specifically, in those with type 2 diabetes. Changes have been made to the advice on diagnosis, starting medications, monitoring, choosing medications and when to refer for same-day specialist review. In this article, the author provides an in-depth review of the NG136 guideline and the changes that have been made. [ABSTRACT FROM AUTHOR]

If treated suboptimally, type 2 diabetes can have devastating long-term complications, including cardiovascular disease, renal disease and blindness; however these can all be prevented. A crucial part of diabetes care is the clinical review, which each person with type 2 diabetes should undergo at least annually. These reviews will often be conducted by non-diabetes-specialist staff in primary care. This article is a guide to the basics that healthcare professionals should be aware of to effectively review a person with type 2 diabetes, related to the 15 healthcare essentials advocated by Diabetes UK. Useful resources for both healthcare professionals and individuals with type 2 diabetes are signposted throughout the article to facilitate enhanced learning. [ABSTRACT FROM AUTHOR]

A growing and significant number of people with diabetes develop chronic kidney disease (CKD). Diabetes‐related CKD is a leading cause of end‐stage kidney disease (ESKD) and people with diabetes and CKD have high morbidity and mortality, predominantly related to cardiovascular disease (CVD). Despite advances in care over the recent decades, most people with CKD and type 2 diabetes are likely to die of CVD before developing ESKD. Hyperglycaemia and hypertension are modifiable risk factors to prevent onset and progression of CKD and related CVD. People with type 2 diabetes often have dyslipidaemia and CKD per se is an independent risk factor for CVD, therefore people with CKD and type 2 diabetes require intensive lipid lowering to reduce burden of CVD. Recent clinical trials of people with type 2 diabetes and CKD have demonstrated a reduction in composite kidney end point events (significant decline in kidney function, need for kidney replacement therapy and kidney death) with sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors, non‐steroidal mineralocorticoid receptor antagonist finerenone and glucagon‐like peptide 1 receptor agonists. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have previously undertaken a narrative review and critical appraisal of the available evidence to inform clinical practice guidelines for the management of hyperglycaemia, hyperlipidaemia and hypertension in adults with type 2 diabetes and CKD. This 2024 abbreviated updated guidance summarises the recommendations and the implications for clinical practice for healthcare professionals who treat people with diabetes and CKD in primary, community and secondary care settings. [ABSTRACT FROM AUTHOR]