Long‐term effectiveness of a community‐based model of care in Māori and Pacific patients with type 2 diabetes and chronic kidney disease: a 4‐year follow up of the DElay Future End Stage Nephropathy due to Diabetes (DEFEND) study. Issue 8 (August 2015) - Tan, J.
Abstract Background/Aim The Delay Future End Stage Nephropathy due to Diabetes study was a randomised controlled trial of Māori and Pacific patients with advanced diabetic nephropathy, comparing a community‐based model of care with usual care. The intervention group achieved lower blood pressure (BP), proteinuria and less end‐organ damage. After the intervention ended, all patients reverted to usual care, and were followed to review the sustainability of the intervention. Methods A retrospective observation of 65 patients (aged 47–75 years) with type 2 diabetes, hypertension, chronic kidney disease 3/4 and proteinuria (>0.5 g/day) previously randomised to intervention/community care or usual care for 11–21 months. Follow up thereafter was until death, end‐stage renal disease (ESRD) (estimated glomerular filtration rate (eGFR) ≤ 10 mL/min/1.73 m2)/dialysis or 1 February 2014. Primary end‐points were death and ESRD/dialysis. Secondary outcomes were annualised glomerular filtration rate decline, non‐fatal vascular events and hospitalisations. Results Median (interquartile ranges (IQR)) post‐trial follow up was 49 (21–81) months and similar in both groups. The median (IQR) eGFR decline was −3.1 (−5.5, −2.3) and −5.5 (−7.1, −3.0) mL/min/year in the intervention and usual care groups respectively (P = 0.11). Similar number of deaths, renal and vascular events were observed in both groups. At the end of follow up, the number of prescribed antihypertensive medications was similar (3.4 ± 1.0 vs 3.3 ± 1.4; P = 0.78). There were fewer median (IQR) hospital days (8 (3, 18) vs 15.5 (6, 49) days, P = 0.03) in the intervention group. Conclusions Short‐term intensive BP control followed by usual care did not translate into reduction in long‐term mortality or ESRD rates, but was associated with reduced hospitalisations.