Endocrine Abstracts

Introduction: All stages of diabetic nephropathy are independent risk factors for cardiovascular disease in patients with diabetes. Intensive intervention to achieve target glycaemic control, blood pressure and cholesterol can minimise cardiovascular risk, mainly by reducing proteinuria.

Aims: To compare two cohorts of patients, group A, attending a nurse-led clinic in addition to the traditional diabetes renal clinic and group B attending the latter only.

Methods: Patients from both clinics, who had at least 2 attendances, from May 2006 to May 2007 were included in the analysis. Data included demographic details, duration of diabetes, HbA1c, blood pressure (BP), lipids as well as urinary albumin creatinine ratio (UACR), both at the beginning and end of this period.

Results: Out of 44 patients in Group A and 48 in Group B, UACR dropped by mean 46.76 (142.83 to 96.0) in group A (P=0.005) vs. a mean 0.56 (99.9 to 99.3) in group B (P=0.976). There was significant reduction in BP in Group A compared to Group B; systolic BP dropped by 6 mmHg (P=0.03 vs 0.92) and diastolic BP by 3 mmHg (P=0.01 vs 0.54). Total cholesterol (TC) reduction was significant in Group A (4.2 to 3.9 mmol, P=0.02) compared to Group B (4.1 to 3.9, P=0.11). No significant improvement in HbA1c was seen in both groups.

Discussion: Nurse-led clinics led to significant improvement in proteinuria, blood pressure and total cholesterol compared to conventional clinics alone. Such clinics generally help achieve targets due to adherence to strict protocols, better compliance and frequent follow-up. Our findings suggest that intensive intervention can reduce risk factors in patients with diabetic nephropathy and should be considered an option wherever possible.