This original research from Jothydev’s Diabetes Research Centre was presented at ATTD (Advanced Technologies & Treatments for Diabetes) in February 2015 at Paris, France and published in Diabetes Technology & Therapeutics.

Chronic Kidney Disease (CKD) is the most disabling and expensive complications of diabetes.The rapid progression of CKD are heralded partly by glucose and partly by fluctuations in blood pressure. Maintenance of acceptable blood pressure is pivotal in preventing the progression of CKD to one requiring renal replacement therapies.

We extracted data of CKD patients from our electronic medical records with an average estimated glomerular filtration rate (eGFR) below 50 mL/min/1.73m2 (CKD stage 3 and 4) and have completed at least 6 years of telemedicine follow up with our Diabetes Tele Management System(DTMS®) to titrate dosages of medications. From this, data of 22 patients who used digital automatic BP apparatus(Omron HEM-7120) at their home for blood pressure monitoring were de-identified. We compared serum creatinine, HbA1c, hemoglobin (Hb), systolic BP, diastolic BP, eGFR at baseline and at six years. Comparison of means was made by paired t-test.

There was no statistically significant change in HbA1c (6.9 vs 7.3, p=0.053). There was a decline in serum creatinine (1.6 vs 2.3, p<0.0001), systolic BP (136 vs 162, p<0.0001), diastolic BP (70 vs 78) and an increase in Hb (12.8 vs. 11.2, p<0.0001) and eGFR (48.5 vs 32.7, p<0.0001).

Compared to those on physical visits to the hospital once in 3 months, those subjects on home BP monitoring, at the end of 6 years showed evidence of stable CKD. Home BP monitoring should be strongly advocated as a cost effective tool in the management of diabetic kidney disease and in prevention of renal replacement therapy.

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