Endocrine Abstracts

Aims: Implementation of a protocol-driven, nurse-led clinic to see influence on cardiovascular risk and renal disease progression using a simple ‘ABC’ approach – target HbA1c <7%, BP <125/75 mm Hg and Cholesterol <4 mmol.

Method: Weekly Diabetes Specialist Nurse (DSN) clinic with emphasis on ABC approach and guided FLORENCE Telehealth free texting technology for medication reminders and self-monitoring of BP (machines provided).

Results: May 2008 – Apr 2009 (12 months) – Cohort A 41 patients. May 2010 – June 2014 (24 months) – Cohort B 133 patients. Mean age 64 years, 78–90% patients Asians/Afro Caribbean. Excellent patient satisfaction scores, significant reductions in HbA1c in Cohort A and B by 0.7% (7.62 vs 8.32%) and 1.5% (9.1 vs 7.6%) respectively, SBP (12–16 mmHg) and DBP (3–6 mmHg) and Cholesterol in all cohorts were achieved. Urine ACR decreased significantly in both cohorts (by mean 17–39 mg/mmol). Number of BP medications (3) increased in all cohorts. 95 and 85% patients respectively in both cohorts were prescribed ACE, ARB or both.

Conclusions: Outcomes suggest that our nurse-led clinic is highly effective in DN patients. The ‘ABC approach’ and simple information sharing strategy (Telehealth FLORENCE) were effectively used to inform strategic decision making/intensification of therapy through patient empowerment, up-skilling of knowledge and improved medication compliance – 3 key processes in any chronic disease management.