The renal diabetic nurse specialist...a luxury or an essential player?

Diabetic Nephropathy is the single largest cause of Chronic Renal Failure. As the number of patients referred to a nephrologist increase, the needs of many diabetic nephropaths are not being met. The post of Renal Diabetes Nurse Specialist (DNS) was instituted in September 1999 to organise the management of and to meet all aspects of need of this group of patients. The role currently incorporates a daily ward round with the aim of reviewing all patients at least once during every admission to hospital. Ward-based teaching with the patients occurs and six nurse-led clinics covering all modalities are now in place and run alongside the Nephrologist. Patients are either referred directly to the nurse-led clinic or are approached by the renal DNS whilst the patient is in the nephrology clinic. 71.4% of our diabetic patients have an improvement in their HbA1c after 21 months of working closely with the Renal DNS and multidisciplinary team. The average HbA1c at the beginning was 9.7%; the average is now 8%. It is clear that the role is being continuously stretched to its absolute limit. Our aim is to develop a broader service over time and we will, in the near future be employing a renal nurse with an interest in diabetes to work alongside the DNS for six months to particularly learn about the needs of our in-patients.