This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mugarza, J. A Articles by Gill, G. V Search for Related Content Social Bookmarking                         What's this?

Achieving blood pressure control in patients with type 2 diabetes and diabetic renal disease by a nurse-led protocol based clinic

Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospitals, Liverpool, UK

John P Wilding

Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospitals, Liverpool, UK

Ann Woodward

Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospitals, Liverpool, UK, a.woodward{at}liverpool.ac.uk

Katharine Hayden

Department of Clinical Biochemistry, Aintree University Hospitals NHS Trust, Liverpool, UK

Geoffrey V Gill

Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospitals, Liverpool, UK

Evidence-based management of type 2 diabetic renal disease requires use of angiotensin - converting enzyme inhibitor (ACE inhibitor) inhibitors or angiotensin receptor blockers (ARBs), with strict blood pressure control which is difficult to achieve in standard doctor-led diabetic clinics and we have therefore developed a nurse-led clinic using a therapeutic algorithm. ACE inhibitor or ARB treatment was maximised, and antihypertensive drugs titrated or added to optimise blood pressure control. Patients were seen monthly until target blood pressure was met, and then discharged for review of blood pressure control 12 months later. Of 71 patients completing the programme, 52 (72%) had microalbuminuria, and 19 (28%) nephropathy. ACE inhibitor or ARB usage increased from 66 to 91% at review (p=0.0004). Systolic blood pressure fell from152±21 to 131±18mmHg (p< 0.0001) and diastolic blood pressure from 76±13 to 68±10mmHg (p<0.0001). Microalbuminuria rates fell but estimated glomerular filtration rates rose. Structured nurse-led clinics are useful in the optimisation of treatment for type 2 diabetic patients with renal disease. Br J Diabetes Vasc Dis, 2008, 8: 279—284

Key Words: angiotensin receptor blocker • ACE inhibitors • blood pressure • nurse-led clinic • microalbuminuria • nephropathy • type 2 diabetes

References

• Ukpds Group. Tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes (UKPDS 38). BMJ 1998;317:703-13.[Abstract/Free Full Text]
• Joss N., Ferguson C., Brown C. et al. Intensified treatment of patients with Type 2 diabetes and overt nephropathy. QJM 97 2004;97:219-27.[Abstract/Free Full Text]
• Parving HH, Lehnert H., Brockner-Mortensen J. et al. The effect of irbesartan on the development of diabetic nephropathy in patients with Type 2 diabetes. N Engl J Med 2001;345:870-8.[Abstract/Free Full Text]
• Lewis EJ, Hunsicker LG, Clarke WR et al. Reno-protective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to diabetes. N Engl J Med 2001;345:851-60.[Abstract/Free Full Text]
• Barnett AH, Bain SC, Bouter P. et al. Angiotensin receptor blockade versus converting enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004;351:952-61.
• Woodward A., Mugarza J., Kahn M. et al. Blood pressure control and ACE-I/ARB usage in nephropathic and microalbuminuric Type 2 diabetes. Practical Diabetes International 2008;25:54-8.
• Department of Health. Diabetes National Service Framework Strategy. London: DoH, 2002.
• European Diabetes Policy Group. A desktop guide to Type 2 diabetes mellitus. Diab Med 1999;16:716-33.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Ramsay LE, Williams B., Johnston GD et al. Guidelines for management of hypertension: report of the third Working Party of the British Hypertension Society. J Hum Hypertens 1999;13:569-92.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Joint British Societies. JBS 2: Joint British Societies' Guidelines on Prevention of Cardiovascular Disease in Clinical Practice. Heart 2005; 91(suppl V): v1-v52.[Free Full Text]
• American Diabetes Association. Standards of Medical Care in Diabetes -2006. Diab Care 2006;29(suppl 1): S4-S42.[Free Full Text]
• Woodward A., Wallymahmed M., Wilding J., Gill G. Successful cardiovascular risk reduction in Type 2 diabetes by nurse-led care using an open clinical algorithm. Diab Med 2006;23:780-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Gaede P., Lund-Andersen H., Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008;358:580-91.[Abstract/Free Full Text]
• Steigerwalt S. Management of hypertension in diabetic patients with chronic kidney disease. Diab Spect 2008;21:30-36.
• Kelly CJG, Booth G. Pharmacist-led structured care for patients with diabetic nephropathy. Br J Diabetes Vasc Dis 2008;8:86-8.[Abstract/Free Full Text]
• Gale EAM. The Hawthorne Studies - a fable for our times? QJM 2004;97: 439-49.[Free Full Text]
• Woodward A., Wallymahmed M., Wilding J., Gill G. Improved glycaemic control: an unintended benefit of a nurse-led cardiovascular risk reduction clinic. Diab Med 2005;22:1272-4.[Medline] [Order article via Infotrieve]

The British Journal of Diabetes & Vascular Disease, Vol. 8, No. 6, 279-284 (2008)
DOI: 10.1177/1474651408098672


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mugarza, J. A Articles by Gill, G. V Search for Related Content Social Bookmarking                         What's this?