Trial opening to assist GPs in managing diabetic kidney disease care

Patient recruitment has started for a trial aiming to enhance the care of adults with diabetic kidney disease (DKD) through a digital multi-component intervention.

Diabetic kidney disease affects around 40% of individuals with diabetes, with a significant number of patients being over the age of 70. The IMPROVE DKD trial, led by the University of Birmingham, will investigate whether computer prompts can assist general practitioners (GPs) in adhering to DKD treatment guidelines, potentially slowing the progression of kidney disease and improving patient outcomes.

“By supporting GPs in adhering to treatment guidelines, this trial has the potential to improve patient outcomes, enhance the care of those with DKD, and reduce healthcare costs.”

Dr Francesca Crowe, University of Birmingham

The trial will be conducted in two phases across 60 GP practices, involving 1,500 patients aged 60-80 years. In the first phase, the research team have developed a computer prompt to help GPs follow key guideline recommendations for blood pressure and blood sugar control, as well as the use of kidney-protecting medications. The prompt will now be tested and optimised within a small number of GP practices. The second phase, starting in the autumn, will test the effectiveness of this intervention in a larger cohort.

The study aims to recruit a diverse range of practices across England, including those with more diverse patient populations, in rural settings and both large and small practices. The practices will be selected via Clinical Practical Research Datalink (CPRD), which will approach the practice about taking part. If the practice agrees, the details will be passed onto the Research Development Networks who will recruit the practice to the trial. The research team will then collect the data on all the eligible patients who visit their GP within each participating practice.

Professor Indranil Dasgupta, chief investigator of the trial, Consultant Nephrologist at Heartlands Hospital and Honorary Professor at the University of Birmingham, said: “The IMPROVE DKD trial is an important step towards addressing the unmet needs of people with diabetic kidney disease. By utilising digital tools to support GPs, we aim to enhance adherence to treatment guidelines and ultimately improve patient care.”

Dr Francesca Crowe, Associate Professor in Epidemiology and Health Informatics at the University of Birmingham and researcher within the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre Data, Diagnostics and Decision Tools theme, added: “Nearly 3.5 million adults in the UK have chronic kidney disease, with around half of them having diabetic kidney disease (DKD). This condition leads to 100,000 hospital admissions and 45,000 premature deaths each year, costing the NHS £6.4 billion annually, primarily for dialysis treatment.

“Given the time pressures GPs face, it is often challenging to adhere to complex treatment guidelines. By supporting GPs in adhering to these guidelines, this trial has the potential to improve patient outcomes, enhance the care of those with DKD, and reduce healthcare costs.”

Dexter, a real-world evidence platform, will enable the trial team to extract large CPRD primary care datasets at the end of the study, providing valuable insights into the effectiveness of the intervention.

The IMPROVE DKD trial is funded by the National Institute for Health and Care Research (NIHR).