Identification, investigation and management of patients with diabetic nepropathy at the primary and secondary care interface.

Doctoral thesis English OPEN
Craig, Kathrine Jane
  • Subject: RC | RA

Approximately 170 million individuals worldwide have been diagnosed with Diabetes Mellitus and between 85--90% of the total population have Type 2 Diabetes Mellitus. Health care is facing an epidemic not only of Diabetes Mellitus but also of the consequence of the attendant morbidity including macro and micro diseases of the vascular system. Of particular interest for the purposes of this thesis, is the progression to nephropathy and development of cardiovascular risk of a proportion of this population and the investigation of strategies that may slow the decline to end stage renal failure and the need for renal replacement therapy or premature death due to cardiovascular disease. Initially, screening practice for microalbuminuria was altered, with patients being identified during their clinic visit, rather than retrospectively. In addition, data on blood pressure levels and antihypertensive agents prescription was collected and collated. Subsequently, a nurse specialist optimised the risk factor management of a cohort of patients with Diabetic Nephropathy using an algorithm driven evidenced based approach. Finally, analysis was undertaken of the factors that might contribute to the development of anaemia in diabetic nephropathy and hence to increased cardiovascular risk. The work described in this thesis demonstrates the inherent complexities of dealing with a problem that involves the maintenance of health within a system that has been set up primarily to deal with the consequences of illness.
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