Endocrine Abstracts

Diabetes is the leading cause of end stage renal failure. So, identifying patients at risk and intensifying management of blood pressure, lipids and glycaemic control can reduce and delay progression to organ replacement therapy. The aim of our study was to determine whether our pilot 3 monthly joint diabetes-renal clinics set up in April 2018 was able to achieve targets outlined by national guidelines and whether patient satisfaction and improved outcomes could lead to further service expansion. We collected retrospective data using electronic records for all 48 patients attending the pilot joint diabetes-renal clinic over a 2-year period. Patient satisfaction was assessed through a self-reported questionnaire. 40 patients had type 2 and 8 patients had type 1 diabetes. The number of hospital visits had significantly decreased from a mean 4.5 to 1.25 visits per year; mean age 68.3 years; mean current eGFR was 27.4 ml/min/1.73 m² (median 26.5) from a mean baseline of 30.2 ml/min/1.73 m² (median 29). The rate of decline of eGFR was 0.11 ml/min/month during this period; mean current blood pressure 154/75 mmHg with 33.3% of patients meeting the target < 130/80 mmHg; current HbA1c 68 mmol/mol vs 77 mmol/mol at baseline; LDL cholesterol 2.03 mmol/l vs 2.7 mmol/l at baseline. 91.6% patients who had no identified contraindication were on lipid lowering drugs. 37.5% patients were not on ACE inhibitors, the top 3 reasons being troublesome hyperkalaemia, significant eGFR drop on initiation and allergic reactions. All 32 patients assessed through a self-reported questionnaire found having both specialties at the clinic appointment to be beneficial as they attended fewer hospital appointments, and they needed less duplication of blood tests as a result of the joint clinic. 21.8% and 18.7% patients felt that it would be beneficial for a diabetes specialist nurse and a dietician to be available at the appointment, respectively. All patients felt that there was clear communication about any changes made to their medication and treatment plan at the appointments. Our findings suggest that the rate of deterioration of renal function can be slowed by aggressive risk factor management. More importantly patient satisfaction considerably improved by attending the joint clinics and will also lead to savings in health care. This will lead to a business case to expand this service further and develop joint diabetes-cardio-renal service to improve the care of patients with complex long-term conditions.