Endocrine Abstracts

Background: Management of diabetes in patients with End Stage Renal Failure (ESRF) is complex, requiring intervention from multiple disciplines. The Joint British Diabetes Societies and Renal Association published the first ever guidelines for the management of patients with diabetes undergoing haemodialysis for ESRF in 2017.

Aims and objectives: Assess Current Care Pathways of all patients with Diabetes undergoing Haemodialysis in Cork University Hospital, Ireland to establish whether management is concordant with the Guidelines of the Joint British Diabetes Societies and Renal Association.

Methods: Structured patient interviews to assess availability and utilisation of diabetes-specific services. Structured interviews with medical, dietetic and nursing staff to assess therapeutic management interventions. Review [HbA1c] over a six month period. The findings were compared with the designated Guidelines.

Results: 49/51 patients took part in interviews. 73% had not attended their G.P. for diabetes specific care in previous 6-months. 35% have never attended a Hospital Diabetes Clinic. 37% had not undergone a foot examination in previous 12 months. 80% followed Renal and Diabetes diets. 84% attended regular retinal screening. Management of Glycaemic Control: diet alone (n=12), oral hypoglycemic agents/insulin (n=39). Recommended [HbA1c] is 58-68mmol/mol. 67% of patients had mean [HbA1c] <58 mmol/mol. 5% had mean [HbA1c] >80 mmol/mol. Interviews with health care staff revealed: 1) an annual review of each patient by disciplinary teams involved in care was not available as recommended by guidelines. 2) absence of routine foot inspection of this high-risk patient group.

Conclusion: Overall, the current Care Pathways do not effectively manage the complex needs of this group. Dietary and ophthalmic management is concordant with recommendations. However, management of glycaemic control and foot complications remain fragmented. The absence of a standardized foot screening care pathway for this patient population is significant and may have an impact on patient outcomes. Furthermore, the HbA1c levels of two thirds of this patient population are below the recommended range of 58–68 mmol/mol. This may indeed highlight that the current therapeutic management of glycaemic control in this patient population may be too tight. The implications of tight glycaemic control in this patient population has not been extensively investigated. Certainly, the findings of this study would suggest that the outcomes of patients with tight glycaemic control should be evaluated further.