Education of diabetic patients with chronic kidney disease and after transplantation

Česká verzia

Authors: A. Jirkovská
Authors place of work: Centrum diabetologie IKEM Praha, přednostka prof. MUDr. Terezie Pelikánová, DrSc.
Published in the journal: Vnitř Lék 2008; 54(5): 530-534
Category:

Předneseno na 9. celostátním diabetologickém sympoziu „Diabetes a urogenitální systém“ ve dnech 1.-2. června 2007 v Novém Adalbertinu v Hradci Králové

Summary

Despite recent advances in the management of diabetes, diabetic nephropathy is the most frequent cause of end-stage renal disease. Even when diabetic nephropathy is established, patient’s care should be optimized to delay progression of nephropathy or other diabetic complications. Evidence exists for the effectiveness of diet intervention, blood pressure and diabetes control and treatment of metabolic syndrome. We emphasize the need for closer co-operation not only between diabetologists, primary care physicians and nephrologists, but with educated diabetic patients, too. At referral to nephrologist, many patients’ care is suboptimal and referral is too late. The most important education information for patients is to stick to diet and keep adequate blood pressure and diabetes control with self- monitoring. Effectiveness of each of these recommendations is critically assessed. Patients after kidney or combined kidney and pancreas transplantation have to be educated mainly in symptoms of rejection and diabetic foot care. They are recommended to take regularly the prescribed medicines, to distinguish the adverse events of immunosuppression and keep all doctor´s appointments.

Key words:
diabetic nephropathy - education - self-monitoring

Zdroje

1. Dunn EJ, Burton CJ, Feest TG. The care of patients with diabetic nephropathy: audit, feedback, and improvement. Q J Med 1999; 92: 443-449.

2. Jirkovská A et al. Jak (si) léčit a kontrolovat diabetes. Praha: Svaz diabetiků 2003.

3. AAFP patient education. Diabetic nephropathy - information from your family doctor. American Family Physician 2005; 72: AAFP Home Page.

4. Diabetes Nutrition Study Group of the EASD. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 2004; 14: 373-394.

5. Thorp MI. Diabetic nephropathy: common questions. Am Fam Physician 2005; 72: 96-99.

6. Mancia G, Facchetti R, Bombelli M et al. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 2006; 47: 846-853.

7. Dart RA. The clinical utility of patient-measured blood pressure at home in the management of hypertension. Clin Med Res 2005; 3: 134-136.

8. McManus RJ, Mant J, Oakes RA. Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis. BMJ 2005; 331: 493-496.

9. Welschen L, Bloemendal E, Nijpels G et al. Self-monitoring of blood glucose in patients with Type 2 diabetes who are not using insulin. Diabetes Care 2005; 28: 1510-1516.

10. Davis W, Bruce DG, Davis TM. Is self-monitoring of blood glucose appropriate for all Type 2 diabetic patients? Diabetes Care 2006; 29: 1764-1770.

11. Heisler M, Smith DM, Hayward RA et al. How well do patients´ assessments of their diabetes self-management correlate with actual glycemic control and receipt of recommended diabetes services? Diabetes Care 2003; 26: 738-743.

12. Thorn LM, Forsblom C, Fagerudd J et al. Metabolic syndrome in Type 1 diabetes. Association with diabetic nephropathy and glycaemic control. Diabetes Care 2006; 28: 2019-2024.

13. Fored CM, Ejerblad E, Fryzek J et al. Socio-economic status and chronic renal failure: a population-based case-control study in Sweden. Nephrol Dial Transplant 2003; 18: 82-88.

14. Saudek F. Příprava na transplantaci. Praha: Maxdorf 2005.