Diabetes education and care management significantly improve patient outcomes in the dialysis unit

McMurray, Stephen; Johnson, Gearold R.; Davis, Stephen N.; McDougall, Kathryn

doi:10.1053/ajkd.2002.34915

Cited by 202 publications

(194 citation statements)

References 16 publications

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“…[81] There is evidence that the incidence of amputations may be substantially reduced by the provision of an integrated program of care for renal patients, especially those on dialysis. [99][100][101] Alternately, a program of education and surveillance by a podiatrist may be very effective. [102] It appears that the introduction of such services should become an urgent priority for all dialysis units.…”

Section: The Diabetic Foot In Renal Failure: Prevention and Treatmentmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

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Section: The Diabetic Foot In Renal Failure: Prevention and Treatmentmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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“…Although these trials excluded patients on hemodialysis, it has been argued that better glycemic control is key toward preventing DM‐related complications in this population 3, 7, 8, 9. In fact, surprisingly few studies have investigated the association between HbA 1c and clinical outcomes in the dialysis population 3, 10, 11, 12, 13, 14, 15, 16. Most of these studies focused only on all‐cause mortality as the outcome and were limited by small sample size and correspondingly low statistical power 11, 12, 13, 15…”

Section: Introductionmentioning

confidence: 99%

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Rhee

Zheng

Montez‐Rath

et al. 2017

JAHA

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BackgroundThere is a lack of data on the relationship between glycemic control and cardiovascular end points in hemodialysis patients with diabetes mellitus.Methods and ResultsWe included adult Medicare‐insured patients with diabetes mellitus who initiated in‐center hemodialysis treatment from 2006 to 2008 and survived for >90 days. Quarterly mean time‐averaged glycated hemoglobin (HbA1c) values were categorized into <48 mmol/mol (<6.5%) (reference), 48 to <58 mmol/mol (6.5% to <7.5%), 58 to <69 mmol/mol (7.5% to <8.5%), and ≥69 mmol/mol (≥8.5%). Medicare claims were used to identify outcomes of cardiovascular mortality, nonfatal myocardial infarction (MI), fatal or nonfatal MI, stroke, and peripheral arterial disease. We used Cox models as a function of time‐varying exposure to estimate multivariable adjusted hazard ratios and 95%CI for the associations between HbA1c and time to study outcomes in a cohort of 16 387 eligible patients. Patients with HbA1c 58 to <69 mmol/mol (7.5% to <8.5%) and ≥69 mmol/mol (≥8.5%) had 16% (CI, 2%, 32%) and 18% (CI, 1%, 37%) higher rates of cardiovascular mortality (P‐trend=0.01) and 16% (CI, 1%, 33%) and 15% (CI, 1%, 32%) higher rates of nonfatal MI (P‐trend=0.05), respectively, compared with those in the reference group. Patients with HbA1c ≥69 mmol/mol (≥8.5%) had a 20% (CI, 2%, 41%) higher rate of fatal or nonfatal MI (P‐trend=0.02), compared with those in the reference group. HbA1c was not associated with stroke, peripheral arterial disease, or all‐cause mortality.ConclusionsHigher HbA1c levels were significantly associated with higher rates of cardiovascular mortality and MI but not with stroke, peripheral arterial disease, or all‐cause mortality in this large cohort of hemodialysis patients with diabetes mellitus.

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“…In addition, glycemic control is essential for reducing the risk of vascular complications and for improving the quality of life of these patients (15)(16)(17). Our study has identified the nephrologist as the most frequent professional responsible for performing glycemic control in diabetic patients undergoing dialysis.…”

Section: Discussionmentioning

confidence: 93%

Glycemic and lipidic profile in diabetic patients undergoing dialysis

Fortes

Mendes

Sesiuk

et al. 2010

Arq Bras Endocrinol Metab

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Objective: The aim of this study is to assess the clinical care pattern and to compare the lipid and glycemic profile in a group of diabetic patients undergoing both hemodialysis (HD) and peritoneal dialysis (PD) and to correlate these data using biomarkers of cardiovascular risk. Subjects and methods: The first phase consisted in performing a survey on demographic data, questions about the medical team and glycemic control. In the second phase, patients were assessed through laboratorial data on their glycemic and lipid profile at a single center for HD and PD. Results: 91 patients was the total population; 70 patients (77%) answered the survey; 66 patients (94%) considered the nephrologist the physician responsible for caring for their glycemic control. Second phase: 59 patients were assessed, 29 undergoing HD and 30 undergoing PD. Fifty-seven percent of the patients had HbA1c above 7%; the level of glycemic markers in patients undergoing peritoneal dialysis was significantly higher than in patients undergoing hemodialysis: HbA1c (9.37 ± 0.5) vs. (7.37 ± 0.49) p < 0.01; fasting glycemia (170 ± 15) vs. (126 ± 15) mg/dL p < 0.05. We found a positive correlation between HbA1c and hyperfibrinogenemia (r = 0.4437, p < 0.0005). Conclusions: The data reveal that glycemic control in diabetic patients undergoing renal replacement therapy (RRT) is neglected. Peritoneal dialysis is related to the worst level of glycemic markers, possibly due to the glucose content in the dialysis solution, and higher levels from HbA1c have a positive correlation with hyperfibrinogenesis in this population. Arq Bras Endocrinol Metab. 2010;54(9):793-800 Keywords Glycemic control; insulin resistance; chronic kidney disease; peritoneal dialysis; inflammation RESUMO Objetivo: Avaliar as características dos cuidados clínicos dos pacientes em diálise, comparar o controle glicêmico e lipídico entre os pacientes diabéticos em hemodiálise (HD) e em diálise peritoneal (DP) e correlacionar os dados laboratoriais com biomarcadores de risco cardiovascular. Sujeitos e métodos: A primeira etapa consistiu de um questionário abordando variáveis demográficas, questões sobre a equipe multidisciplinar, incluindo a equipe médica e sobre o controle glicêmico. Na segunda, os pacientes foram avaliados com exames laboratoriais para controle glicêmico e perfil lipídico numa unidade de HD e DP. Resultados: Dos 91 pacientes avaliados, setenta (77%) responderam ao questionário. Destes, 66 (94%) consideraram o nefrologista o médico responsá-vel pelo cuidado do seu controle glicêmico. Na segunda etapa, foram avaliados 59 pacientes: 29 em HD e 30 em DP. Cinquenta e sete por cento dos pacientes diabéticos em diálise apresentaram HbA1c acima de 7%, sendo que aqueles em diálise peritoneal apresentam níveis de marcadores glicêmicos significativamente piores do que os pacientes diabéticos em HD, HbA1c: (9,37 ± 0,5) vs. (7,37 ± 0,49) p < 0.01; glicemia de jejum: (170 ± 15) vs. (126 ± 15) mg/dL, p < 0.05. Encontramos uma correlação positiva entre HbA1c e hiperfibrinoge...

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Diabetes education and care management significantly improve patient outcomes in the dialysis unit

Cited by 202 publications

References 16 publications

The Diabetic Foot in End Stage Renal Disease

The Diabetic Foot in End Stage Renal Disease

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Glycemic and lipidic profile in diabetic patients undergoing dialysis

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