It had been well known that the multidisciplinary team approach (MTA) contributes to remission of microalbuminuria in persons with type 2 diabetes, whereas it remains unclear as to whether MTA improves macroalbuminuria, a risk factor of progressive kidney failure. To investigate the effect of MTA on progression of diabetic kidney diseases (DKD) in the subjects with diabetes and macroalbuminuria, 24 subjects were managed by MTA (n=11), or by dietitian approach alone (DA, n=13) during January 2012 and December 2022. The team, which consists of physicians, nurses, and dietitians, provided support and education for DKD subjects: [1] pathophysiology and stages of DKD, [2] medications, [3] daily measurements of blood pressure, blood glucose, and body weight, [4] how to check edema, and [5] medical diet therapy based on estimated protein and salt intake from 24-hour urine collection. There was no significant difference between MTA and DA in types of diabetes, gender, age, frequencies of interventions, and the initial eGFR. HbA1c levels in MTA group (7.5±1.5) was significantly lower than those in DA group (9.7±2.8 %)(p=0.021). During the intervention period, there was a numerical decrease in albuminuria levels in MTA group (906.7 to 349.6 mg/gCr, p=0.511), whereas a numerical increase in DA group (785.1 to 1841.5 (p=0.064). Five subjects were initiated hemodialysis in the DA group, but not in MTA group. DKD stage was improved (A3 to A2) in four MTA subjects during the intervention period. The annual rate of eGFR decline during 4-year observation was significantly better in MTA group than in DA group (-2.78±4.42 vs, -8.18±6.9 mL/min/1.73m2/y, p=0.031). Thus, MTA is likely to prevent deterioration of DKD, compared with DA alone, in DKD subjects with macroalbuminuria. Further studies would be needed to uncover the effects of MTA in the prevention of other diabetic complications.
M. Hitomi: None. T. Moriya: None. T. Miyatsuka: None. N. Hiki: None.
