Intensive multifactorial intervention reduces end points in patients with diabetic nephropathy. Traditional clinics struggle to provide the intensity of care required to meet targets for this growing patient group. We designed a pharmacist-led, protocol driven clinic to offer stepwise intensive treatment to patients with diabetic nephropathy picked up at the traditional secondary care clinic. One hundred and sixteen individuals received more than one review. The clinic achieved significant improvements in blood pressure (BP): systolic 151±19 mmHg vs.133±15 mmHg (p<0.001), diastolic 80±10 mmHg vs. 68±10 mmHg (p<0.001) and total cholesterol 4.56 mmol/L±1.05 mmol/L vs. 4.03±1.07 mmol/L (p<0.001). Albumin:creatinine ratio also improved 27±44 vs. 20±31 (p=0.02). Structured intervention within a pharmacist-led clinic has led to a rapid and significant reduction in BP and cholesterol in microalbuminuric patients. This format of care can form the basis of patient focused, target driven, care.
Ritz E., Orth SRNephropathy in patients with type 2 diabetes mellitus. N Engl J Med1999;341:1127-33.
2.
UK Prospective Diabetes Study Group.Tight blood pressure control and risk Nof macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ1998;317:703-13.
3.
Fried L., Orchard T., Kasiske B., for the Lipids and Renal Disease Progression Meta-analysis Study Group.Effect of lipid reduction on the progression of renal disease: A meta-analysis. Kidney International2001;59:260-9.
4.
Parving HH, Lehnert H., Brochner-Mortensen J. et al. The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes. N Engl J Med2001;345:870-8.
5.
Brenner BM, Cooper ME, de Zeeuw D. et al. Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy. N Engl J Med2001;345:861-9.
6.
Gaede P., Vedel P., Larsen N., Jensen GVH, Parving HH, Pedersen O.Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes. N Engl J Med2003;348:383-93.
7.
Joss N., Ferguson C., Brown C., Deighan CJ, Paterson KR, Boulton-Jones JMIntensified treatment of patients with type 2 diabetes mellitus and overt nephropathy. QJM2004;97:219-27.
8.
Joss N., Paterson KR, Deighan CJ, Simpson K., Boulton-Jones JMDiabetic nephropathy: how effective is treatment in clinical practice?QJM2002;95:41-9.
9.
Scottish Intercollegiate Guidelines Network (SIGN).Management of Diabetes2001;20-23
10.
Williams B. , Poulter NR, Brown MJ et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ2004;328:634-40.
11.
Leung WY, So WY, Tony PC et al. Effects of structured care by a pharmacist-diabetes specialist team in patients with Type 2 diabetic nephropathy. Am J Med2005;118:1414.e21-1414.e27.
