Identification and management of diabetic nephropathy in the diabetes clinic.
OBJECTIVE
To examine the prevalence and management of diabetic nephropathy in a diabetes clinic.


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.
Craig
Kathrine J
KJ
Institute of Nephrology, University of Wales College of Medicine, Heath Park, Cardiff, UK.
Donovan
Kieron
K
Munnery
Margaret
M
Owens
David R
DR
Williams
John D
JD
Phillips
Aled O
AO
D000368:Aged; D000419:Albuminuria / Q000652:urine; D000554:Ambulatory Care Facilities; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D003404:Creatinine / Q000652:urine; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine