How recent guidelines could help evolve the type 2 diabetes care landscape – DiabetesTimes.co.uk

In an exclusive interview, AstraZeneca Cardiovascular, Renal and Metabolic Unit Director Matt Bunyan discussed with the Diabetes Times the impact type 2 diabetes has on comorbidities, and how recent NICE guideline changes have the potential to improve care.
What is the unmet need in type 2 diabetes (T2D) and what impact does this have on comorbidities such as cardiovascular and renal disease?
More people than ever are now living with diabetes in the UK and 90 per cent have type 2 diabetes (T2D).[1] The need for better management is high due to the comorbid nature of T2D: people with this condition are prone to a number of other associated complications such as cardiovascular (CVD) and renal disease, premature death, depression and sight loss.^[2],[3]
CVD is one of the major causes for healthcare inequality in the UK,[4] and although glycaemic control of course remains an important part of T2D, we must recognise that assessing CVD risk in T2D patients is vital as well. This was reflected in February 2022, when the National Institute for Health and Care Excellence (NICE) updated their NG28 guidelines, placing greater emphasis on personalised care as well as managing cardiovascular risk when identifying and managing long-term complications in patients with type 2 diabetes.[5]
Similarly, renal diseases such as chronic kidney disease (CKD) are common comorbidities for people living with T2D,[6] and the disease burden is growing here, with approximately 68,000 people in the UK requiring dialysis because they have progressed to end-stage kidney disease.[7] The NHS spends at least £10 billion a year on diabetes care but almost 80 per cent of this comes from treating diabetes-related complications.1 Therefore, there is a real need to improve diabetes care across the spectrum and better manage related comorbidities like CVD and CKD to transform patient outcomes.
At AstraZeneca, we are committed to the effective management of serious chronic diseases like T2D by providing solutions and therapies for the millions of people affected by the complex spectrum of cardiovascular, renal, and metabolic diseases. We are proud to be unravelling the underlying causes of these diseases by identifying novel targets linked to disease biology to create the next generation of therapeutics.
How can we improve care for T2D patients, especially those with related co-morbidities?
We need to take a more personalised and holistic view of care, treating someone with T2D through the lens of all interconnected organs and systems as opposed to just diabetes in isolation. There are encouraging signs that we are moving in this direction. The NG28 guideline updates are one example: they encourage healthcare professionals and physicians to adopt an individualised approach to care that is tailored to the needs and circumstances of adults with T2D and identify those at risk of CVD at their T2D diagnosis, or in subsequent reviews so that care can be targeted accordingly.⁵
This is a major step in the right direction for how these conditions are understood and treated. Alongside this, other steps include patient education, dietary advice, managing cardiovascular risk and blood glucose levels, as well as identifying and managing long-term complications with a strong focus on managing CVD in people with T2D.
The entire diabetes community, including patients, physicians, carers, and patient organisations, are striving to change the trajectory for people living with T2D. Collaboration between these different groups will underpin any progress we make, and to that end we at AstraZeneca are always looking for opportunities to do this: for example, by partnering with healthcare professionals to deliver patient education as well as digital platforms that can enable them to transform patient outcomes.
What impact could effective implementation of the NG28 guidelines have?
If we are able to accelerate implementation of the new NICE guidelines, we may be able to help tackle some of the biggest issues facing the NHS today, including hospitalisations for diabetes-related complications and the unprecedented workload in primary care. In other words, the NG28 guidelines not only map out a more holistic approach to T2D care, but implementing them could help manage the high burden placed on our healthcare systems, particularly in our post-COVID world.
The burden of T2D and its related comorbidities on people, healthcare systems and economies is startling, particularly when we consider that many of these conditions remain undiagnosed and undertreated. Because many of these conditions are interconnected, our approach to care must be too – and this is what the NG28 guidelines are now recommending. It is a much-needed evolution in how we approach T2D, and AstraZeneca have already had many productive discussions with people from across the T2D community about the impact that effective NG28 guideline implementation could have. By working together to make this happen, we can find better solutions across the T2D landscape, and address associated comorbidities like CVD or CKD where there remains a significant unmet need.
Read more about our innovative approaches and partnerships with the healthcare community to increate education and awareness in the UK: https://diabetestimes.co.uk/the-big-interview-astrazenecas-matt-bunyan/
[1] Diabetes UK. Diabetes Statistics. Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics. Last accessed: November 2022.
[2] Diabetes UK. Diabetes and Heart Disease. Available at: https://www.diabetes.org.uk/guide-to-diabetes/complications/cardiovascular_disease. Last accessed: November 2022.
[3] Diabetes UK. Diabetic Nephropathy (Kidney Disease). Available at: https://www.diabetes.org.uk/guide-to-diabetes/complications/kidneys_nephropathy. Last accessed: November 2022.
[4] British Heart Foundation, The CVD challenge. Available at: https://www.bhf.org.uk/for-professionals/healthcare-professionals/data-and-statistics/the-cvd-challenge. Last accessed: November 2022.
[5] National Institute for Heath and Care Excellence. Type 2 diabetes in adults: management
NICE guideline [NG28]. Published: 02 December 2015. Last updated: 29 June 2022. Available at: https://www.nice.org.uk/guidance/ng28/chapter/Recommendations. Last accessed: November 2022.
[6] Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol. 2016; 12:73–81
[7] Kidney Care UK. Facts and stats. Available at: https://www.kidneycareuk.org/news-and-campaigns/facts-and-stats/#:~:text=There%20are%2040%2D45%2C000%20premature,UK%20will%20develop%20kidney%20failure. Last accessed November 2022.
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Date of preparation: November 2022
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