6. Halting CKD Progression in Diabetes with Virtual Interactions- a 5 year Retrospective Analysis

This original research was presented by Dr.Jothydev Kesavadev at San Diego, USA at the 77th Scientific Sessions of American Diabetes Association in June 2017 from Jothydev’s Diabetes & Research Centres, Kerala.

Background

Chronic Kidney Disease (CKD) is a common comorbidity associated with diabetes. For 45% of patients who receive dialysis therapy, diabetes is the primary cause of their kidney failure. HbA1c >7%, as well as hypertension, increases the risk for clinical and structural manifestations of diabetic nephropathy. Once developed, CKD has a natural progression which could effectively be halted in its early stages with optimal control of blood glucose, blood pressure (BP), lipids and lifestyle modifications. In routine clinical practice, it is seldom possible to reassess customized targets and address the huge inter-day and intra-day variations.

Aim


CKD being a complication with serious physical, emotional and economic consequences, we explored the possibility of using simple technologies aided with telemedicine program to sustain individualised lifestyle and metabolic targets to slow down progression of CKD. The positive clinical outcomes of diabetes therapy on halting CKD progression was assessed among our T2DM patients who were in early stages of kidney disease.

Methods

Clinical profiles of T2DM patients detected with Stage 3 CKD as of January – December 2010 were de-identified. Patients who had optimal follow-up (once weekly virtual consultations via Diabetes Tele Management System, DTMS® and physical visits every 3 months) and adherence to therapies and lifestyle advice were selected. Their 5-year retrospective data were analysed.

Results

In 166 T2DM patients, (age 61.83±9.15 years, diabetes duration 23.5±10.2 years, 76% male) no significant changes were observed in any of the parameters viz. Creatinine, eGFR, BP, Spot microalbumin, HbA1c and Hb even after 5 years of CKD development.

Conclusions

Our results reveal the positive outcomes achievable with a systematic diabetes management in halting the progression of commonly associated comorbidity CKD. With the implementation of dose alterations, education and motivation through virtual consultations the progression of CKD was successfully halted in majority of our patients.

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