Abstract: TH-PO729

Improvement of Glycaemic Control in Patients with Diabetes and CKD through a “One-Stop” Joint Diabetes Kidney Clinic

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Patel, Jayna, St HELIER HOSPITAL, LONDON, United Kingdom
  • Sodani, Niyati, St. George's, University of London, London, United Kingdom
  • Wahba, Mona, st Helier Hospital NHS Trust, London, United Kingdom
Background

Diabetic nephropathy is a significant complication of diabetes mellitus and is associated with increased cardiovascular morbidity and mortality. There is substantial evidence to show that optimal glycaemic control has a significant impact on the progression of diabetic nephropathy. There is no consensus regarding the best model for following up patients with diabetes and CKD in the outpatient setting.

Methods

We conducted a single centre, retrospective observational analysis of patients that attended a monthly ‘one stop’ joint diabetic and nephrology clinic between 2013 and 2016. This newly established service is run by a consultant nephrologist, endocrinologist and diabetic specialist nurse. Reasons for referral were suboptimal diabetic control, hypoglycaemic episodes in the context of CKD, or where renal function had deteriorated to a point necessitating a change in diabetic medications (e.g. a switch to insulin). They were also referred for further management of weight gain and new onset diabetes after transplantation (NODAT).

Results

A total of 93 patients were reviewed in the clinic. Mean age was 65 years [39-92years]. 57 patients were male and 36 were female. Mean HbA1c of patients at referral was 73 [35-151]. Mean eGFR at referral was 33.6 ml/min [9-90ml/min]. 69.9% of patients were type 2 diabetics and 45% of these patients were switched to an insulin based regimen. 16 patients were started on liraglutide and their mean eGFR at referral was 52.7mls/min [24-90 ml/min]; 13 of these patients were followed up at 1 year and 92% of these patients had lost weight and had a stable eGFR, mean 51.6mls/min [23-90ml/min]. At 1 year follow up, 71% saw an improvement in HbA1c (p<0.05, paired t test).

Conclusion

This study showed that this model of care for patients with diabetes and CKD may be used to help improve diabetic control. Liraglutide, a glucagon-like peptide-1 receptor agonist, seems to be an effective agent to promote weight reduction in patients without causing deterioration in renal function.