Quality of treatment of diabetics in renal failure in Germany

Background and objective: In recent years there has been a rapid increase i n the number of dialysis-dependent diabetics in Germany. Survival on dialys is is not satisfactory and damage acquired in the preterminal stage of rena l failure is thought to play an important role. Late referral to a nephrolo gist and insufficient quality of medical management are thought to contribu te importantly to poor outcome. This hypothesis was evaluated in the presen t study. Patients and method: The data of all 173 diabetic patients (16 with type 1, 157 with type 2 diabetes, 90 men, 83 women, mean age 63,3 [31-95] years), who had been referred in 1996 for the first time to five renal units, were retrospectively assessed using a structured protocol. Results: Patients were usually referred in advanced renal failure (median c reatinine clearance 29 ml/min, range 1-216) with insufficient control of sy stolic (170 [120-260] mmHg) and diastolic blood pressure (90 [60-180] mmHg) , insufficient antihypertensive therapy (without treatment 32 of 173 patien ts; median number of classes of antihypertensive agents used 2 [range 1-6]; ACE inhibitors 79 of 173 patients), high HbA(1c) (7.9 [4.9-15.7] %) and ID L cholesterol (176 [67-307] mg/dl). Immediate dialysis was required in 45 p atients. Conclusion:The data document insufficient quality of treatment and late inc orporation of a nephrologist into the medical team involved in the care of diabetic patients. Changes in the structure of diabetes care are necessary to improve treatment quality.