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They write, “Structured care delivered by a pharmacist-diabetes specialist team reduced the incidence of end-stage renal disease or death compared with usual care in patients with type 2 diabetic nephropathy.”
The researchers conducted a two-year study where the clinical outcomes of patients managed by a structured-care protocol were compared to a group receiving usual care in the same hospital. Patients younger than 80 years of age who had type 2 diabetes, a serum creatinine between 150 and 400 micromol/l, and micro- or macroalbuminuria were recruited. A pharmacist-diabetes specialist team implemented the structured-care protocol with particular emphasis on “periodic laboratory assessments, patient adherence, risk factors control and use of renin-angiotensin system inhibitor.”
During 22.8 months of follow-up, kidney disease or all-cause death respectively developed in 24 and 40 patients in the structured care and usual care groups.
“Structured care slowed the rate of [kidney] decline,” write the researchers. “More intensive laboratory measurements, increased use of renin-angiotensin system inhibitor and greater reductions in blood pressure and low-density lipoprotein (LDL) cholesterol were reported by patients receiving structured care.”
—American Journal of Medicine, December 2005
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