|
 |
|
|||||||
|
|||||||||
© 2003 by the American Diabetes Association, Inc.
Epidemiology/Health Services/Psychosocial Research |
Identification and Management of Diabetic Nephropathy in the Diabetes Clinic
1 Institute of Nephrology, University of Wales College of Medicine, Cardiff, U.K.
2 Diabetes Research Unit, Academic Centre, Llandough Hospital, Penarth, U.K.
OBJECTIVE—To examine the prevalence and management of diabetic nephropathy in a diabetes clinic.
RESEARCH DESIGN AND METHODS—Characteristics of nephropaths identified by existing screening practice (phase I, albuminuria >20 mg/l in three separate urine samples), were compared with those identified by a nurse-led management program (phase II, in which screening for nephropathy was based on albumin-to-creatinine ratio in a single random urine specimen).
RESULTS—In phase I, 644 patients attended a diabetes clinic over a 6-month period. Microalbuminuria results were available for 485 patients (75%). A total of 115 patients were identified as nephropaths (prevalence 17.8%). Of these patients, 91% had type 2 diabetes. During phase II, prospective analysis of urinary albumin-to-creatinine ratio was carried out in 880 patients over 8 months. A total of 174 patients were identified as nephropaths (prevalence 20%). Of these, 134 patients had been identified by existing screening protocols. Forty had no previous record of microalbuminuria and were therefore newly identified by prospective screening. Systolic blood pressure guidelines were met in only 31% of all known nephropaths and 26.5% of newly diagnosed nephropaths. Diastolic blood pressure guidelines were met in 36% of all known and 38% of newly diagnosed nephropaths. In the patient group of known nephropaths from phases I and II, 62% were prescribed ACE inhibitors (ACEIs) or angiotensin II receptor (AIIR) antagonists. In the newly identified nephropathy patient cohort from phase II, 48% used ACEIs or AIIR antagonists.
CONCLUSIONS—Introduction of a nurse-led management program significantly improved detection of nephropathy. We are currently evaluating its impact on clinical management.
Abbreviations: ACEI, ACE inhibitor • AIIR, angiotensin II receptor • HOT, Hypertension Optimal Treatment • UKPDS, U.K. Prospective Diabetic Study
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  M. B. Davidson, A. Ansari, and V. J. Karlan Effect of a Nurse-Directed Diabetes Disease Management Program on Urgent Care/Emergency Room Visits and Hospitalizations in a Minority Population Diabetes Care, February 1, 2007; 30(2): 224 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Middleton, R. N. Foley, J. Hegarty, C. M. Cheung, P. McElduff, J. M. Gibson, P. A. Kalra, D. J. O'Donoghue, and J. P. New The unrecognized prevalence of chronic kidney disease in diabetes Nephrol. Dial. Transplant., January 1, 2006; 21(1): 88 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Gross, M. J. de Azevedo, S. P. Silveiro, L. H. Canani, M. L. Caramori, and T. Zelmanovitz Diabetic Nephropathy: Diagnosis, Prevention, and Treatment Diabetes Care, January 1, 2005; 28(1): 164 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. Rubio-Guerra, A. Arceo-Navarro, G. Vargas-Ayala, L. Rodriguez-Lopez, J. J. Lozano-Nuevo, and C. T. Gomez-Harper The Effect of Trandolapril and Its Fixed-Dose Combination With Verapamil on Proteinuria in Normotensive Adults With Type 2 Diabetes Diabetes Care, July 1, 2004; 27(7): 1688 - 1691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Thomas Collaboration between hospital and primary care can improve the management of diabetic nephropathy The British Journal of Diabetes & Vascular Disease, May 1, 2004; 4(3): 202 - 204. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |