Background: The severity of kidney disease predicts mortality and intensive glycaemic control reduces the risk of progression of diabetic nephropathy. It is therefore important to optimise glycaemic control in patients with chronic diabetic nephropathy who are not yet requiring dialysis to try to slow the rate of decline of renal function.
Aim: To assess (i) the adequacy of diabetes control (HbA1c), (ii) the frequency of referral to the Endocrinology Unit of inpatients with chronic diabetic kidney disease admitted under the Nephrology team at Western Health, Melbourne, and (iii) the impact of Endocrinology referral on glycaemic control.
Method: We conducted a retrospective audit of patients admitted under the Nephrology Unit between October 2013 and September 2015 with chronic diabetic nephropathy (stage 3 or above) who were not on dialysis.
Results: We identified 46 inpatient episodes (34 individual patients), with a mean age of 64 years, eGFR of 27 ml/min/1.73m2, and HbA1c of 7.4% (57 mmol/mol), 15% had HbA1c >8.5% (69 mmol/mol). Fifty percent of these had no documentation of any previous Endocrinology input (public or private). Of these patients, 43% had new referrals during the admission. The patients who were referred to Endocrinology tended to have a worse baseline HbA1c (7.3% vs 6.8%, p=0.48). While there was a trend towards a greater improvement in HbA1c in referred patients when reassessed several months later, this did not achieve statistical significance (HbA1c difference of -0.78% vs -0.16%, p=0.3).
Conclusion: This study demonstrates that the overall HbA1c results were only modestly elevated in this population, although caution is needed in interpreting this as HbA1c may not be reliable in patients with chronic kidney disease. The Endocrinology Unit was not consistently utilised in inpatients with diabetic nephropathy. There may be benefit in obtaining Endocrinology input to improve glycaemic control, but further studies are needed to validate this.