Diabetes and chronic kidney disease: a complex combination.

Diabetes and chronic kidney disease (CKD) are two disease processes that remain with patients from diagnosis to the end of their lives. Both are destructive conditions that must be diagnosed early to prevent longer-term complications, such as retinopathy and neuropathy. Diabetes remains the single most important cause of kidney failure. Diabetes in hospital accounts for 10% of all admissions, but this figure is much higher within renal medicine with diabetes significantly increasing length of stay, with excess bed days suggested at 20%. Inpatient care is currently the largest single component of medical costs for diabetes, while diabetes costs 10% of the NHS budget. The number of patients with both diabetes and CKD are increasing, and to help slow down the progression to complications patients must receive education on how to control their diabetes. Training packages are designed to facilitate this educational process but the NHS needs to invest in refresher courses as the educational structure needs to support lifetime learning. It is vital from first referral that all patients lead in the decisions made about their health. Healthcare professionals have a duty of care to ensure patients are given clear, concise and accurate information in language they understand with the use of medical terminology and jargon limited. Patients must then be allowed to gather their thoughts and ask any further questions before supporting them in the choices that they make.