Key result
Nurse-led clinic linked to a ~21 mmHg systolic blood pressure drop in diabetic kidney disease.
Why the study?
Strict blood pressure control in type 2 diabetic renal disease is difficult to achieve in standard doctor-led diabetic clinics.
Does a nurse-led protocol-based clinic improve blood pressure control and guideline-directed medical therapy usage in patients with type 2 diabetes and diabetic renal disease?
Observational (n=71)
Does a nurse-led protocol-based clinic improve blood pressure control and guideline-directed medical therapy usage in patients with type 2 diabetes and diabetic renal disease?
Absolute Event Rate: 131% vs 152%
p-value: p=<0.0001
A structured nurse-led clinic using a therapeutic algorithm significantly improves blood pressure control and the utilization of ACE inhibitors or ARBs in patients with type 2 diabetes and renal disease.
May support nurse-led BP protocols in diabetic kidney disease; leaves open whether this improves hard outcomes in RCTs.
Evidence-based management of type 2 diabetic renal disease requires use of angiotensin - converting enzyme inhibitor (ACE inhibitor) inhibitors or angiotensin receptor blockers (ARBs), with strict blood pressure control which is difficult to achieve in standard doctor-led diabetic clinics and we have therefore developed a nurse-led clinic using a therapeutic algorithm. ACE inhibitor or ARB treatment was maximised, and antihypertensive drugs titrated or added to optimise blood pressure control. Patients were seen monthly until target blood pressure was met, and then discharged for review of blood pressure control 12 months later. Of 71 patients completing the programme, 52 (72%) had microalbuminuria, and 19 (28%) nephropathy. ACE inhibitor or ARB usage increased from 66 to 91% at review (p=0.0004). Systolic blood pressure fell from152±21 to 131±18mmHg (p< 0.0001) and diastolic blood pressure from 76±13 to 68±10mmHg (p<0.0001). Microalbuminuria rates fell but estimated glomerular filtration rates rose. Structured nurse-led clinics are useful in the optimisation of treatment for type 2 diabetic patients with renal disease. Br J Diabetes Vasc Dis, 2008, 8: 279—284
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Mugarza et al. (2008) conducted an observational in Type 2 diabetes and diabetic renal disease (n=71). Nurse-led clinic using a therapeutic algorithm vs. Baseline was evaluated on Systolic blood pressure (p=<0.0001). A nurse-led clinic using a therapeutic algorithm reduced systolic blood pressure from 152 to 131 mmHg (P<0.0001) in patients with type 2 diabetes and diabetic renal disease.
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