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Delivering improved management and outcomes in diabetic kidney disease in routine clinical care
Kevin J Hardy
Whiston Diabetes Centre, Merseyside, UK, kev.hardy{at}bigfoot.com
Niall J Furlong
Whiston Diabetes Centre, Merseyside, UK
Shirley A Hulme
Whiston Diabetes Centre, Merseyside, UK
Sarah V O'Brien
Whiston Diabetes Centre, Merseyside, UK
Aim
To examine the impact of service re-design on management and outcomes in type 2 diabetic patients with microalbuminuria and diabetic nephropathy.
Methods
The impact of implementation of evidence-based processes of care (blood pressure [BP] control, glycaemic control, renin-angiotensin-aldosterone system blockade, aspirin and cholesterol-lowering therapy, and smoking cessation) on progression to nephropathy in 338 microalbuminuria patients; and on death, doubling of serum creatinine, new end-stage renal failure (ESRF) and cardiovascular events in 127 nephropathy patients is described.
Results
Effective implementation of evidence-based processes of care improved surrogate outcomes (BP, HbA 1C and low density lipoprotein-cholesterol), was associated with little progression of microalbuminuria to nephropathy (6.1 per 100-patient-years), and in diabetic nephropathy patients were associated with rates of doubling of serum creatinine (1.4 per 100-patient-years), progression to ESRF (1.1 per 100-patient-years), cardiovascular events (3.2 per 100-patient-years) and mortality (2.2 per 100-patient-years) that compares favourably with landmark trials.
Conclusion
Service re-design in the management of type 2 diabetic kidney disease can deliver improved care and outcomes comparable with landmark trials in a routine clinical care setting.
Key Words: death • diabetes mellitus • dialysis • doubling of serum creatinine • microalbuminuria • nephropathy.
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The British Journal of Diabetes & Vascular Disease, Vol. 7, No. 4,
172-182 (2007)
DOI: 10.1177/14746514070070040101
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