Does intensive management of patients with diabetic kidney disease using a protocol-based, nurse-led clinic improve renal and cardiovascular outcomes?

Summary

Diabetes is more prevalent in Sandwell and the West Birmingham area than the national and regional average. Diabetic Nephropathy (DN) is a major cause of premature death in patients with all types of diabetes. Although nurse-led clinics are generally believed to be successful, there is very little data on their impact with DN patients. The team set up a protocol-driven, diabetic renal nurse-led review clinic to specifically target education and adopt an ‘ABC’ approach, evaluating results over 3 different time periods between 2003 and 2014 in a mixed ethnic population. There were statistically significant reductions in HbA1c, patient satisfaction scores were high and medication compliance increased. A quarter of patients were referred to a Low Clearance Renal Clinic in a timely manner as per renal/NSF guidelines.

Challenge

Diabetes is more prevalent in Sandwell and West Birmingham CCG (around 10.1%) compared with the national and regional average (based on continuing rise in elderly population, growing obesity and BME groups). The prevalence of diagnosed diabetes among people aged 17 years and older is 7.9% compared to 6.1% in similar CCGs. Social deprivation is high and compliance is a major issue. Diabetic kidney disease or Diabetic Nephropathy (DN) is major cause of premature death in patients with all types of diabetes. These patients are at high risk of developing end stage renal failure (requiring renal replacement therapies) as well as cardiovascular morbidity and mortality. There is good evidence that stringent control of glycaemia, blood pressure and aggressive CV risk management can delay progression of DN and CV mortality.

Objectives

Currently the Diabetes Renal team in the Trust see around 24 patients per week (4-6 new, 18-20 follow up) costing the CCG between £3,000 - £3,300 weekly, annualised to £156,000 to £172,000. The waiting list for new patients is between 3-6 weeks and is imperative that they are seen and treated quickly to reduce long term complications and prevent future costly interventions. The basic objective was to see if a specialist nurse-led clinic could influence CV risk through basic education, increasing drug compliance and uptake of statins/aspirin/ACE/ARB and halt progression of renal disease in patients with DN using a simple ‘ABC’ approach of targeting HbA1c, Blood Pressure and Cholesterol.

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QiC Diabetes Commended 2015
Best initiative for the prevention, or earlier detection, of diabetes
Does intensive management of patients with diabetic kidney disease using a protocol-based, nurse-led clinic improve renal and cardiovascular outcomes?
by Birmingham City Hospital



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