Renal Insufficiency and Diabetes Mellitus
Conditions
Keywords
diabetes mellitus, type 2, kidney diseases, primary care, prevention, early diagnosis
Brief summary
This work will make it possible to identify the nephron loss of type 2 diabetic patients in the western region and to better define in general practice the impact of the elements put in place to reduce this loss and to raise awareness of the importance of these measures through training in comparison with a control group.
Interventions
OTHERtraining and audit
An evaluation of the practices with clinical audit before and after the management will be carried out.Every 3 months for 2 years, the investigating physicians of the intervention group will report for these patients the modifications or cessation of treatment, modification or implementation of interventions such as physical activity or implementation of nutritional modifications. Physician investigators will be asked to report any occurrence of adverse events to their regional pharmacovigilance centers.10 possible actions to be deployed : 1. Hygienic and dietary measures 2. Physical activity 3. Smoking cessation 4. Avoidance of nephrotoxic substances 5. Treatment of hypertension 6. Proteinuria reduction 7. Oral antidiabetics; choice 8. Optimal HBA1c 9. Statin 10. Compliance
OTHERRoutine care
Physicians in the control group will receive training on the study procedures. An evaluation of practices with a clinical audit before and after the treatments will be carried out. Every 3 months for 2 years, the investigating physicians in the control group will report for these patients the modifications or cessation of treatment, the modification or implementation of interventions such as physical activity or the implementation of modifications in terms of nutrition. The investigating physicians will be asked to report any occurrence of adverse events to their regional pharmacovigilance centers. Physician investigators in the control group will continue their care as usual.
Sponsors
University Hospital, Lille
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient consulting his or her investigating general practitioner * 50 years old or more * type 2 diabetic for more than 5 years, with a GFR lower than 90 ml/mn and higher than 45 ml/mn (stage 2 and 3a of renal failure) and a nephron loss calculated on the average of the two previous years, higher than 3 ml/mn/year * a microalbuminuria \> 30 mg/gr of creatinuria. * Having declared the investigator as the treating physician
Exclusion criteria
* Patient under 50 years of age Patients who do not agree to the use of their data (refusal of consent) or are unable to give consent (dementia, other) Patients with other types of diabetes Patients with renal failure other than diabetic or hypertensive glomerulopathy Patients unable to give consent Patients who do not understand the French language Patients with less than 3 months of planned follow-up Patients with a barrier to follow-up Patients undergoing dialysis, transplantation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in annual glomerular filtration rate (GFR) slope | Every 3 months during 2 years | the annual glomerular filtration rate (GFR) slope calculated as the difference between the estimated loss over the two years before inclusion (N-2) and the estimated annual loss over the follow-up years after inclusion. |
Secondary
| Measure | Time frame |
|---|---|
| Audit of clinical practices | before randomization, at 6 months and 24 months in the 2 groups |
| Cumulative incidence of unscheduled hospitalizations for all reasons at 2 years from the start of care in the intervention group compared to the control group | At 2 years (the end of the study) |
| change of Albuminuria | at baseline and every 3 months during the 2-year follow-up. |
Outcome results
None listed