Diabetic kidney disease trial seeks to improve treatment in primary care

A trial aiming to improve the management of diabetic kidney disease in general practice has secured $1.4 million in health research funding.

Over the next three years, 22 practices will participate in the project, which includes funding for nursing and kaiāwhina support staff. 

Funded by the Health Research Council and led by Aotearoa Clinical Trials in partnership with Health New Zealand Te Whatu Ora, the research also has the support of ProCare, the National Hauora Coalition and Tāmaki Health. 

It will involve 11 intervention practices and 11 control practices. To be eligible, each needs at least 100 patients with diabetes with signs of renal disease.

“We can’t just keep doing the same things we’ve been doing because things are getting worse”  

According to estimates from the 2023 Te Whatu Ora virtual diabetes register, 323,700 people in Aotearoa have diabetes, with those of Māori, Pasifika and Indian ethnicity having the highest rates.  

The Rethinking Diabetic Kidney Care Together project’s lead investigator, Viliami Tutone, is a nephrologist at Middlemore Hospital. He says diabetes treatment costs the health system $2.1 billion annually, with growth projections increasing. 

At a presentation on the study at Auckland’s Te Manukanuka o Hoturoa marae yesterday, Dr Tutone discussed “a conveyor belt” of patients moving from primary care to renal care to the graveyard.

The trial, he says, is about slowing the disease’s progression through targeted support for primary care.  

Participating practices will receive funding for additional nursing and kaiāwhina support. GPs will also have access to a specialist portal and a monthly conference with renal and diabetes specialists to discuss complex cases.

“We need some change out there,” Dr Tutone says. “We can’t just keep doing the same things we’ve been doing because things are getting worse.”  

Te Whatu Ora director of Pacific health, Makerita Poutasi, also attended Thursday’s meeting to discuss the project and described diabetes as a national pandemic. 

Diabetes Foundation Aotearoa chair and Te Whatu Ora endocrinologist John Baker is one of the investigators for the study. Dr Baker says a lot of effort and resources go into treating the disease but not enough into prevention. 

He says the trial is focused on general practice because that is where 85 per cent of type 2 diabetics, who comprise most people with the disease, are treated. 

Dr Baker hopes to have the project up and running by July. 

During a health select committee hearing in Parliament in February last year, Te Whatu Ora director of population health gain Gary Jackson said the number of people with diabetes in New Zealand grew by 20,000 annually. Dr Jackson was speaking after the release of the Te Whatu Ora Aotearoa New Zealand Health Status Report 2023. 

He said diabetes was a particular issue for the Pacific, Māori and Indian populations, as about half of all people of Pacific and Indian origin having diabetes by the time they were 79.  

ProCare clinical director and specialist GP Allan Moffitt says addressing the impact of long-term conditions like diabetes and kidney disease is a priority for the PHO.  

“So, I’m quite excited to be involved with this, and it aligns with the work we are already doing.” 

ProCare has about 15 practices that would meet the criteria for the study, Dr Moffitt says. 

“And we will be looking at using our resources to support this study,” he says. “We really need a circuit breaker because what we’ve been doing hasn’t been very effective.” 

Mana Whenua i Tāmaki Makaurau health board chair Robert Clark (Waikato-Tainui) welcomed the study and says it’s a positive development.  

“If we don’t carry out the trial, how do we know it will work?” Mr Clark says. “If research like this doesn’t have our DNA, our blood, our real-life data, it doesn’t have anything.”   

Mana whenua is obligated to support it, so future generations don’t suffer the same burden of diabetes, he says.