Achieving blood pressure control in patients with type 2 diabetes and diabetic renal disease by a nurse-led protocol based clinic

Abstract

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