Endocrine Abstracts (2003) 6 DP21

An Audit On Adherence To Renal Guidelines in Prevention and Early Management of Renal disease in Type 2 Diabetes

R Srinivasan1, GA Thomson2, VS Kumar2 & D Fernando2


1Diabetes and Endocrinology Unit, Nottingham City Hospital, UK; 2John Paes Diabetes Centre, Kings Mill Hospital, Sutton in Ashfield, UK.


Introduction

Renal disease in type 2 diabetes can be prevented and limited with early detection and management of the condition. We studied the adherence of renal guidelines introduced by national institute of clinical excellence (NICE), in patients who attended the annual review in the last 12 months.

Methods

Audit standards were based on guidelines for Prevention and Early Management of Renal disease in Type 2 Diabetes, issued by NICE in February 2002. Renal care for all type 2 diabetes patients were studied by looking into percentages of Albumin: Creatinine ratio (ACR) measured, serum creatinine done, serum cholesterol checked and patients who had ACR classified into high or low risk in the last 12 months. Care for the patients with high risk was studied by looking into management of patients who had creatinine more than 150 micromoles/ litre.

Results

In diabetes annual review clinics the following observations were made in type 2 diabetes patients

95%of patients had Dipstick for urinary protein done. 10% had ACR or Microalbuminuria done and classified into high or low risk of developing renal disease

80 % had Creatinine checked

60% had Cholesterol checked

30% had HbA1C less than 7.5 grams %

In high risk group

85% of patients had Angiotensin Converting Enzyme (ACE) inhibitors started

30%had Blood Pressure less than 140/80

12% with creatinine more than 150 micromoles/litre were referred to nephrologist

Conclusion

Our audit identifies renal guidelines were not followed and diabetes team were instructed to adhere to the guidelines in prevention and management of renal disease in type 2 diabetic patients. The present results highlight the difficulties faced when attempting multiple risk factor modification in patients who have high risk for developing renal disease. New hospital guidelines and targets were set with regards to the investigation and management. The audit is to be repeated in a year.

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