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Nov 17, 2019

International Diabetes Federation Congress 2019

Educational program to suppress the progression of diabetic nephropathy

education

diabetes

nephropathy

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education

diabetes

nephropathy

Abstract

Background: Diabetic nephropathy is characterized by urine albumin excretion, diabetic glomerular lesions, and loss of glomerular filtration rate (GFR). The number of patients with diabetic nephropathy which is a major cause disease of introduction of dialysis is increasing year by year, and is a big issue in Japan. In our hospital, therefore, since 2012, a multidisciplinary team consisting of physicians, nurses and dietitians has implemented an intervention program aimed to prevent the progression of diabetic nephropathy. Aims: We aimed to examine the efficacy of our educational program to prevent the progression of mild diabetic nephropathy. Method: This was a retrospective study for patients with early stage of diabetic nephropathy (66 males, 34 females, 67.9 ± 10.9 years old). The inclusion criteria were as follows; those who had microalbuminuria (eGFR > 30 ml/min/1.73m2, urinary albumin 30-299 mg/gCRE), and who had been started the intervention program during the period of 2012-2014. Interventions were conducted once every 2-3 months, physicians, nurses, and dietitians worked together on the same day; physicians checked medical conditions, adjusted medication and advised lifestyle modifications, nurses confirmed the adherence to the medication, the psychological burden on the treatment, and the implementation of foot care, and dietitians evaluated the dietary intakes and advised the dietary balance correction and sodium restriction. In order to verify the effectiveness of this intervention program, we collected HbA1c and eGFR values for 7 years before and after the intervention from electronic medical records, and investigated the change rates before 3 years and after 3 years of the interventions. Results: Although HbA1c tended to be increasing gradually after the start of the intervention over 7 years (7.4 to 7.6%), no statistically significant change was observed. eGFR showed a significant decline over the three years before the intervention (72.4 to 68.0 ml/min/1.73m2). However, in the 3 years after the intervention, the eGFR decline over time was suppressed, there was no statistically significant change before and after the intervention (68.0 to 66.9 ml/min/1.73m2). Furthermore, when comparing the eGFR reduction rates between before and after 7 years of the intervention, the reduction rate after the intervention showed significantly lower than before (-0.02% vs. -0.01%, p<0.01). Discussions: We observed that renal function was maintained after the intervention compared to that before the introduction of the intervention program. Therefore, it is suggested that a multidisciplinary approach with doctors, nurses and dietitians is effective for preventing the development of early-stage diabetic nephropathy.

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All rights reserved.