Endocrine Abstracts

Aim: To audit clinical outcomes and adherence to prescription recommendations in a diabetes renal clinic.

Method: Baseline data was compared to the final clinic visit within a 12 month period, using information from clinic letters and electronic records of patients attending our hospital diabetes renal clinic in 2016 (1st January – 31st December). Patients with at least 1 follow-up within a 12 month period were included.

Results: 82 patients were seen in total. 64 patients had full medicines management review whilst the pharmacist individually reviewed 34 patients. Complete data for this audit was available in in 48/82 patients. 30/48 (62%) were males. Ethnicity distribution was - Asian 17, Afro-Caribbean 16, Caucasian 12, others 3. A mean reduction in HbA1c from 75 to 70 mmol/mol (P=0.01) was achieved. Systolic blood pressure reduced from 136.8 to 137.2 mmHg (NS). No significant change in diastolic blood pressure was seen either (71.5 to 71.0). Significant urinary albumin:creatinine ratio (ACR) improvement was observed: 49 down to 40 mg/mmol (P<0.01). 28/64 (43%) patients were not on an antiplatelet agent. 60/64 (94%) were on a lipid-lowering agent. 47/64 (73%) patients received an ACE inhibitor, ARB or both. 9/48 (19%) patients were either referred to renal physicians or discussed in the renal-diabetes MDT. 11/48 (23%) patients used Telemedicine and patient held records to improve self – management skills (FLO Telemedicine-8, Patient Knows Best PKB-3).

Conclusion: These results suggests that the nurse-led clinic is effective in reducing HbA1c and urine ACR levels in this high CV risk patients and should help improve cardiovascular and renal outcomes in future. Pharmacist presence helps improve medication knowledge and adherence - most patients received lipid-lowering agents and majority were on ACE/ARBs, whilst aspirin prescription remained low. We hope to further improve results as the clinic progresses to its full potential in future.