title: A combined diabetes renal clinic improves risk factor management and progression of renal disease in a district general hospital.
abstract: OBJECTIVE
  Aggressive management of vascular risk factors reduces the rate of progression to end-stage renal failure in patients with diabetic nephropathy. The aim of our audit was to clarify whether improvements in patient care could be demonstrated within a short time period after establishing a combined diabetes renal clinic in a district general hospital.
  
  
  METHODS
  A retrospective analysis of weight, glycaemic control, blood pressure control, rate of decline in renal function and appropriate use of medications for vascular risk management for patients in a district general hospital was performed before and after attendance at a combined diabetes renal clinic.
  
  
  RESULTS
  Data were complete for 45 patients. There was no significant change in weight from 14 months before attending the combined clinic, referral to the clinic and after 14 months of mean follow-up. An improvement in mean systolic blood pressure was achieved at the combined diabetes renal clinic (from 147 to 134 mmHg with an average fall of 16.5 mmHg, P < 0.01). The mean glycated haemoglobin (HbA1c) improved from 8.6% to 8% (P = 0.002). The rate of decline in estimated glomerular filtration rate of 1.16 mL min(-1) per month prior to referral improved to 0.21 mL min(-1) per month on attending the combined clinic (P = 0.002).
  
  
  CONCLUSIONS
  Vascular risk factor management was improved and decline in renal function slowed in patients with diabetic nephropathy within a short period of establishing a combined diabetes renal clinic in a district general hospital.
authors.affiliation: Monklands Hospital, Airdrie, UK.
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.forename: Ilona R
authors.initials: IR
authors.lastname: Shilliday
authors.forename: Gerard A
authors.initials: GA
authors.lastname: McKay
mesh_terms: D003925:Diabetic Angiopathies / Q000517:prevention & control*; D003929:Diabetic Neuropathies / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011787:Quality of Health Care; D051437:Renal Insufficiency / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012606:Scotland