Endocrine Abstracts

Aim: To audit outcomes and adherence to prescription recommendations in a nurse-led Diabetic Renal Clinic.

Method: Baseline data at time of referral to the clinic was compared to the final clinic visit within a 12-month period (T1) of the first visit (T0), using information from clinic letters and electronic records of patients attending the clinic in our hospital between 2010 and 2014. Patients without at least one follow-up data within a 12-month period were excluded.

Results: We had complete data in 91/208 patients seen. Average age was 63 years and 54 were males. A mean reduction of HbA1c from 74 to 69 mmol/mol (P=0.01) was achieved. Systolic blood pressure reduced from 152 to 142 mmHg (P<0.01), although no significant change in diastolic blood pressure was seen (75–73, P=0.113). Significant urinary albumin:creatinine ratio (ACR) improvement was observed – 53 down to 31 mg/mmol (P<0.01). Renal function declined from eGFR 54 to 51 ml/min per 1.73 m² (P=0.001). There was no significant difference in total cholesterol (4.4–4.3, P=0.371). 50 patients (54%) were not on an antiplatelet agent at T1. All of these patients had at least one risk factor (age 50 years or above, systolic BP above 145 or microalbuminuria) and thus aspirin would have been indicated. Six of 17 (35%) patients not on a statin were prescribed one by T1. 79 (86%) were on a lipid-lowering agent at T1. 85% received an ACE inhibitor, ARB, or both.

Conclusion: These results from 1 year follow-up suggests that the nurse-led clinic is effective in reducing HbA1c, systolic blood pressure, and urine ACR levels in this high CV risk patients. This should hopefully result in improved cardiovascular and renal outcomes and appropriate referrals to renal specialist clinic. Most patients received lipid-lowering agents and ACE inhibitors/ARBs, whilst aspirin prescription remained low.