Tackling Type 2 Diabetes and Kidney Disease: Tools, Technology and Resources

Dr Lucy Francis MBBS, MRCP (UK) 

LONDON March 23: Chronic kidney disease affects around 850 million people worldwide — significantly more than those living with cancer worldwide (1). By 2040, it is expected to become the fifth leading cause of death globally (2). A recent report in the UK already calls it a public health emergency, with costs projected to reach nearly £14 billion a year by 2033 without urgent action (3).

I’m a kidney doctor nearing the end of my training and about to start a research degree (MD) at the University of Cambridge, focusing on kidney autoimmune disease. I look after people with diabetic kidney disease as well as other kidney conditions, including those undergoing dialysis or transplantation. I’d like to highlight five important areas that I believe can help improve outcomes for South Asians living with diabetes or chronic kidney disease: 1) knowing and working towards agreed health targets 2) making the most of new diabetes technology 3) increasing our participation in clinical trials 4) having more open conversations about organ donation and 5) raising awareness of, and making use of, the support and resources available to us.

1. Knowing and working towards agreed targets
If you have type 2 diabetes, it’s important to know your targets for blood sugar and blood pressure and work towards them. The website Diabetes UK has a great A4 “information prescription” you can download or print and use with your doctor to set personalised goals for your HbA1c (your average blood sugar over the past 2–3 months), blood pressure, and cholesterol. They also offer unit converters if your blood tests were done in India, where different units may be used.

Poorly controlled diabetes can lead to complications with your eyes, kidneys, feet, and blood vessels. Regular checks — like eye exams, urine tests for protein, and foot assessments—are vital to your health if you have diabetes. Guidance on how often these should be done is on the NICE (National Institute for Health and Care Excellence) website. Similarly, if you have reduced kidney function, it’s helpful to know your key test results — such as your eGFR, creatinine, and urine protein levels — and to understand how they’re changing over time. As with diabetes tests, unit converters are available online if your get these blood tests periodically done in India.

2. Embracing new diabetes technology
Secondly, there have been big technological advances in blood sugar monitoring. Flash (intermittently scanned) and continuous glucose monitors (CGMs) check sugar levels in the fluid around your cells. CGMs are worn on the arm and show your sugar levels in real time on a phone app. They can spot trends early, helping you avoid highs and lows, and you can share data with your doctor to adjust treatment to keep your sugars in the target range for longer. Some CGMs now work with insulin pumps (called closed-loop systems) or smart pens, for type 1 diabetics, helping people match insulin doses with sugar levels more easily.

For type 2 diabetes on the NHS, flash sugar monitoring may be available for those on insulin who have severe episodes of low blood sugar, a lack of awareness of these episodes of low blood sugar, or need carer support. They can also be bought privately, but can be expensive. New NICE guidance is expected in July 2025, which may expand who can access them on the NHS. By raising awareness of these new technologies, we can empower our community — to spread knowledge, support one another, and make the most of tools that can improve diabetes care and outcomes. Also — a reminder: a home blood pressure machine costs around £20! We should all have one in our homes and we should be using it especially when South Asian adults in the United Kingdom may face high blood pressure-related heart risks earlier in life. Agree a blood pressure target with your doctor and try to avoid adding salt at the table- use herbs and spices instead.

3. Improving participation in clinical trials
Thirdly, clinical trials can often offer early access to promising new treatments that may not yet be available otherwise. Some people worry about safety, but trials are carefully regulated, so it is always worth considering and discussing with your specialist if you are offered the chance to participate. Asian communities are underrepresented in research — which means results of studies may not fully apply to us. Taking part in trials helps ensure future treatments work better for our bodies, our communities, and our families.

4. Organ donation
We also need to have family conversations about organ donation. According to the 2023/24 NHS Blood and Transplant report, only 32% of Asian families give permission for organ donation after death, compared to over 64% of Caucasian families (4).

After five years on the kidney transplant list, 77% of Caucasian and 73% of ethnic minority patients receive a transplant, while around 6–7% sadly die waiting. Black patients wait five months longer on average than white patients (median: 612 days for Black, 586 for Asian, 448 for white). There are many complex reasons for this but over time, it is predicted that the differences in the waiting times across ethnic minority groups will be reduced with the introduction of a revised kidney offering scheme in 2019.

The number of Asian patients waiting for an organ transplant has increased by 32% in the last five years. At the same time, the number of Asian living donors has gone down by 27%. There has been some progress — with an 8% increase organ donation after death amongst Asians — but challenges remain (4). Often a reason families say no to organ donation is that they’re unsure on what their loved one would have wanted because they never talked about it. Having these conversations matter, it could save someone’s life.

5. Raising awareness of available support and resources
Finally, this is a list of valuable resources for people with diabetes or chronic kidney disease.
1) Action on Salt- A group of specialists concerned with salt and its effects on health. We should only be ingesting a maximum of 5-6g of salt a day. On average in the UK we consume 8.4g of salt. The website provides free salt surveys that are very enlightening! https://www.actiononsalt.org.uk/
2) Kidney Beam- This is a brilliant free app for exercise sessions and wellbeing support tailored especially for people with kidney conditions. The website is https://www.kidneybeam.com/
3) Kidney Care UK- This is a charity with a great number of chronic kidney disease resources, kidney friendly recipes from Kidney Kitchen and other free materials. They also can help with financial grants for people living with kidney conditions. https://kidneycareuk.org/
4) DVLA- Guidance on when you should inform the DVLA about your diabetes. https://www.gov.uk/diabetes-driving
5) NICE and UK Kidney Association- Talk to your doctor about personalised targets for blood pressure and HbA1c, based on this guidance. www.ukkidney.org, www.nice.org.uk/guidance/NG136
6) Diabetes UK- for information prescriptions where you can make targets with your doctor. www.diabetes.org.uk/about-diabetes/looking-after-diabetes/information-prescriptions
7) Should you take a statin? This is a great NICE decision aid to help you decide. www.nice.org.uk/guidance/ng238/resources/patient-decision-aid-on-should-i-take-a-statin-pdf-243780159

And for those curious about the science behind the medications you may be taking:
1) On dapagliflozin, canagliflozin, or empagliflozin?
These medications were studied in major trials for type 2 diabetes and kidney disease called CREDENCE, DAPA-CKD, and EMPA-KIDNEY.
You can read more about the DAPA-CKD trial here: https://www.nejm.org/doi/full/10.1056/NEJMoa2024816

2) Taking semaglutide (ozempic)?
This GLP-1 medication was studied in the FLOW trial for diabetes and kidney disease. You can read more about the trial here: www.nejm.org/doi/full/10.1056/NEJMoa2403347
Being informed, asking questions, and taking part in conversations and research can be a powerful step toward better health in our communities.

Dr Lucy Francis MBBS, MRCP (UK) – Clinical Research Fellow, Nephrology Registrar at Addenbrooke’s Hospital, Cambridge