title: The care of patients with diabetic nephropathy: audit, feedback, and improvement.
abstract: Diabetic nephropathy is the commonest cause of end-stage renal failure in the developed world. The quality of care of 152 patients with diabetic nephropathy was assessed at the time of referral to a single nephrologist. The type II diabetics (62%) were older than the type I diabetics (38%) (mean 65 years vs. 48 years). The mean duration of diabetes was 17 years. Significant cardiovascular disease was present in 52%. There was diabetic retinopathy in 84% of the type I diabetics and 53% of the type II diabetics. Overall, 63% had hypertension at referral (St Vincent Declaration criteria), untreated in 25%. ACE inhibitors were not prescribed in 48% when no contraindications to their use were present. Glycosylated haemoglobin was > 9.1% in 29%. Twenty were prescribed medications inappropriate to their renal function. Of patients with ischaemic heart disease and serum cholesterol > 5.5 mmol/l, 82% were untreated; 82% of patients with secondary hyperparathyroidism were also untreated. At initial referral, many patients' care was sub-optimal. Referral was too late for adequate preparation for renal replacement therapy in 33%. Following a process of education and feedback of the results to referring practitioners, the timing of referral improved. We emphasize the need for closer co-operation between those managing diabetic patients with nephropathy to optimize their care.
authors.affiliation: Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Dunn
authors.forename: C J
authors.initials: CJ
authors.lastname: Burton
authors.forename: T G
authors.initials: TG
authors.lastname: Feest
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006962:Hyperparathyroidism, Secondary / Q000628:therapy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors