Patient and professional partnership in diabetic nephropathy

Diabetes mellitus (DM) is a complex multifaceted metabolic disorder characterised by chronic disease processes of hyperglycaemia and changes in the metabolism of carbohydrates, fats and proteins. It holds no boundaries with age, gender, culture or social strata. It is a life long disease process, which belongs to the individual, impacting on physical, social, psychosocial and spiritual life experiences. Diabetes is a worldwide burden to healthcare providers. In the United Kingdom (UK) 1.4 million people are affected with a suspected million people undiagnosed. A significant subgroup of patients with DM are predisposed to developing diabetic nephropathy, and it is now the single commonest cause of end-stage renal failure, accounting for 16% of new patients taken on to renal replacement therapy each year. It is in this subgroup that other diabetes related complications such as retinopathy, neuropathy and peripheral vascular disease are also concentrated. Microalbuminuria is an early indicator of renal disease in diabetes, and also predictive of total mortality, cardiovascular mortality and cardiovascular morbidity. These associated macro and microvascular complications can result in high personal, social and financial costs of managing complications associated with diabetic nephropathy and end-stage renal disease (ESRD). Some ethnic groups are particularly vulnerable--in the UK, the incidence of ESRD in South Asians and African Caribbean's is three times higher than in White Caucasians, in part due to the high prevalence of diabetic nephropathy.