Primary Care Knowledge Boost

Doctors Lisa and Sara talk to Consultant Nephrologist Dr Darren Green about patients with Type 2 Diabetes who also have Chronic Kidney Disease and Heart Failure. 

We go through a hypothetical case to illustrate some of the finer points of management that can commonly get missed or might not be appreciated. A really detailed talk full of useful practice enhancing tips for this complex group of patients. 

Disclaimer: All educational content in this podcast was developed as part of the Circulation Health collaborative working project between Boehringer Ingelheim Limited, Greater Manchester Primary Care Provider Board and Health Innovation Manchester. Content has been created by Circulation Health Clinical Leads for educational purposes, reflecting NHS Clinical Lead and guideline-based recommendations. Boehringer Ingelheim had no input into content development. They have provided financial resources to support Podcast recordings related to this project.

Darren would like us to make you all aware that he has working relationships with pharmaceutical industry partners. Specifically, that he has received speak fees and consultancy fees from AstraZeneca, GSK, Novartis, Boehringer Ingelheim, Bayer, and Lilly, and has been part of collaborative working agreements with Novartis, Boehringer Ingelheim, and AstraZeneca.

You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)

Resources:

Dr Kevin Fernando counselling diabetic patients starting an SGLT2 Inhibitors like Dapagliflozin or Empagliflozin: https://www.youtube.com/watch?v=pc99SdtlsyU

Diabetes UK counselling sheets on SGLT2 inhibitors: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/sglt2-inhibitors

Kidney Care UK Patient Booklets: https://kidneycareuk.org/get-support/free-resources/patient-information-booklets/

Pumping Marvellous Heart Failure Charity with patient resources: https://pumpingmarvellous.org/

International Society for Nephrology Toolkit for Initiating or Changing RAASi - Renin Angiotensin Aldosterone System Inhibitors (like ACEis such as Lisinopril or Ramipril, or ARBs like Candesartan on Losartan): https://www.theisn.org/initiatives/toolkits/raasi-toolkit/

Royal College of General Practitioners Acute Renal Failure Toolkit: https://elearning.rcgp.org.uk/course/info.php?id=899

CONFIDENCE trial: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes | New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2410659

ATLAS trial: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus: https://pubmed.ncbi.nlm.nih.gov/11071803/

Metformin lactic acidosis Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review: https://jamanetwork.com/journals/jama/article-abstract/2084896

UK AKI Summit report UKKA AKI Summit Report + Recommendations: https://share.google/7uw1GPQ5sV2riJtiV

RCGP AKI follow up  post discharge recommendations: https://bjgpopen.org/content/early/2020/06/15/bjgpopen20X101054/tab-figures-data?versioned=true

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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback

Email us at: [email protected]

___

This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 

The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.

Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.

The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are back with Consultant Neurologist Dr Antonella Macerollo for this episode about Parkinson’s disease. 

We look at a typical case and discuss what Parkinson’s is, the differentials, the need for time to discern between these, and the options for treatment. Links include information on Clinical Trials and Parkinson’s UK which is an active Charity linking resources together for patients and professionals. Thanks to Alison Day at Parkinson’s UK for making the connection between ourselves and Antonella to make these episodes possible.

You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)

 

Resources:

Parkinson’s UK: https://www.parkinsons.org.uk/

The epidemiological link between Essential Tremor and Parkinson’s Disease: https://www.nature.com/articles/s41531-023-00577-y

PD Frontline (clinical trial in Parkinson's disease): https://pdfrontline.com/en

Cure Parkinson’s: https://cureparkinsons.org.uk/

Parkinson’s Europe Charity (good resources): https://parkinsonseurope.org/

___

We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback

Email us at: [email protected]

___

This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 

The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.

Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.

The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa discuss the podcast episodes over the year. We talk about our longer term learning points, how the year has gone and what's to come.

___

We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback

Email us at: [email protected]

___

This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 

The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.

Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.

The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak to Consultant Neurologist Dr Antonella Macerollo about Essential Tremor (ET). We take a case and go through what ET is, how it might present, differentials and the differences between other conditions, how it might affect people and what management options there are. 

This is the first of two Episodes with Dr Antonella Macerollo, our next one is about Parkinson’s Disease. Thanks to Alison Day at Parkison’s UK for making the connection between ourselves and Antonella to make these episodes possible.

You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)

Resources:

More Differentials and details of clinical assessment of Tremors: https://patient.info/doctor/history-examination/tremor-pro?utm_source=gpoptin

Revisiting the assessment of tremor: clinical review. Vijiaratnam N, Wirth T and Morris HR. British Journal of General Practice 2020; 70 (701): 611-614. https://bjgp.org/content/70/701/611

Treatment for essential tremor: a systematic review and Bayesian Model-based Network Meta-analysis of RCTs. Zhang, Junjiao et al. eClinicalMedicine, Volume 77, 102889: https://www.thelancet.com/action/showCitFormats?doi=10.1016%2Fj.eclinm.2024.102889&pii=S2589-5370%2824%2900468-1

Parkinson’s UK: https://www.parkinsons.org.uk/

The epidemiological link between Essential Tremor and Parkinson’s Disease: https://www.nature.com/articles/s41531-023-00577-y 

___

We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback

Email us at: [email protected]

___

This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 

The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.

Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.

The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Consultant Nephrologist Dr Darren Green about patients with Type 2 Diabetes who also have Chronic Kidney Disease and Heart Failure. 
We go through a hypothetical case to illustrate some of the finer points of management that can commonly get missed or might not be appreciated. A really detailed talk full of useful practice enhancing tips for this complex group of patients. 

Disclaimer: This episode was supported by Greater Manchester NHS who received support from Boehringer. 

You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)


Resources:

Dr Kevin Fernando counselling diabetic patients starting an SGLT2 Inhibitors like Dapagliflozin or Empagliflozin: https://www.youtube.com/watch?v=pc99SdtlsyU

Diabetes UK counselling sheets on SGLT2 inhibitors: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/sglt2-inhibitors

Kidney Care UK Patient Booklets: https://kidneycareuk.org/get-support/free-resources/patient-information-booklets/

Pumping Marvellous Heart Failure Charity with patient resources: https://pumpingmarvellous.org/

International Society for Nephrology Toolkit for Initiating or Changing RAASi - Renin Angiotensin Aldosterone System Inhibitors (like ACEis such as Lisinopril or Ramipril, or ARBs like Candesartan on Losartan): https://www.theisn.org/initiatives/toolkits/raasi-toolkit/

Royal College of General Practitioners Acute Renal Failure Toolkit: https://elearning.rcgp.org.uk/course/info.php?id=899

CONFIDENCE trial: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes | New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2410659

ATLAS trial: Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus: https://pubmed.ncbi.nlm.nih.gov/11071803/

Metformin lactic acidosis Metformin in Patients With Type 2 Diabetes and Kidney Disease: A Systematic Review: https://jamanetwork.com/journals/jama/article-abstract/2084896

UK AKI Summit report UKKA AKI Summit Report + Recommendations: https://share.google/7uw1GPQ5sV2riJtiV

RCGP AKI follow up  post discharge recommendations: https://bjgpopen.org/content/early/2020/06/15/bjgpopen20X101054/tab-figures-data?versioned=true

___

We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback

Email us at: [email protected]

___

This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 

The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.

Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.

The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.