Journal Article

Early referral of Type 2 diabetic patients: are we ready for the assault?

Giorgina Barbara Piccoli, Giorgio Grassi, Elisabetta Mezza, Massimo Gai, Candida Iacuzzo, Francesca Bechis, Luigi Biancone, Alberto Jeantet, Franco Dani, Paolo Cavallo Perin and Giuseppe Paolo Segoloni

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 17, issue 7, pages 1241-1247
Published in print July 2002 | ISSN: 0931-0509
Published online July 2002 | e-ISSN: 1460-2385 | DOI:
Early referral of Type 2 diabetic patients: are we ready for the assault?

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Background. Elderly diabetics on dialysis are dramatically increasing in number. Their late referral reduces efficacy of therapeutic interventions; early referral is fundamental for their survival on dialysis. However, need for nephrological follow‐up in case of early referral is not assessed. The objective was to define the need for follow‐up in the nephrology setting of Type 2 diabetics, according to the early referral criteria of serum creatinine ≥1.5 mg/dl or macroproteinuria.

Methods. The setting of the study was an outpatient diabetic care unit (University of Torino), where ∼25% of the Type 2 diabetics of a 900 000‐inhabitant city (Torino, Northern Italy) were followed. At the time of the study (1998–1999) the unit followed 5182 Type 2 diabetics whose serum creatinine and proteinuria were tested at least yearly. A total of 3826 prevalent and 478 incident patients with one or more analyses in the same laboratory were included in the study. Demographic data were not statistically different between selected and excluded patients. We calculated the stepwise need for nephrological follow‐ups calculated according to our usual policy (4–12 evaluations/ year, on serum creatinine and proteinuria, and 30 min/evaluation).

Results. The prevalence of increased serum creatinine and macroproteinuria was high (in the prevalent cohort: serum creatinine ≥≥1.5 mg/dl, 8.1%; proteinuria 0.3 g/day, 25.2%; serum creatinine ≥3 mg/dl, 1.2%; nephrotic proteinuria 3.4%). Projecting data to the entire unit, with adherence to our evaluation protocol, early nephrological follow‐up of Type 2 diabetics requires ∼1300 h/year (one full‐time nephrologist); five nephrologists are needed for our city, and 24 for the region (4350 000 inhabitants).

Conclusions. Early nephrological referral and follow‐up of Type 2 diabetics is time consuming and expensive. Meeting the outpatient care needs of this critical cohort requires considerable resources.

Keywords: end‐stage renal disease; proteinuria; serum creatinine; Type 2 diabetes

Journal Article.  4823 words. 

Subjects: Nephrology

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