Blood pressure control in Māori and Pacific patients with type 2 diabetes
Optimising blood pressure control in Māori and Pacific patients with type 2 diabetes mellitus and established diabetic nephropathy in New Zealand: The Delay Future End-stage Nephropathy due to Diabetes (DEFEND) Study. Dr C Hotu. PhD Thesis.
Synopsis: In a randomised controlled trial 69 Māori and Pacific patients with type 2 diabetes, moderate CKD and hypertension were randomised to conventional care or nurse-led community care intervention for 12 months. Community care patients received monthly visits by a nurse-led Māori and Pacific health care assistant for blood pressure measurement, checking adherence to medication, medication side effects and significant clinical events. If the blood pressure was above the target of 130/80 mmHg, a study doctor altered antihypertensives following a set protocol. Transport was offered to the community group for prescription collection, blood tests and study clinic appointments. Routine care continued for both groups but the usual care group only received GP and outpatient clinic care. The DEFEND group clinicians saw these patients at baseline and 12 months only and made no blood pressure management decisions. The model of care proved to be more effective than conventional care in lowering systolic BP, 24-hour urine protein and delaying progression of cardiac and renal end-organ damage. The author concludes from this analysis that ‘... this model of health care delivery is significantly more effective than conventional care in lowering systolic BP, and reducing cardiac and renal end-organ damage in these high-risk patients’ (Houtu 2013, ii).
Details can be found on the HIIRC site and is available to download and read in full text at: https://researchspace.auckland.ac.nz/handle/2292/20586.
