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Item
#5
New Strategies
for Prevention and Treatment of Diabetic Renal Disease
50% of the
patients in dialysis units have type 2 diabetes and continues to
increase.
Over the
last 35 years an increasing number of patients with type 2
diabetes have developed advanced renal disease and the need for
dialysis. At present in the US, about 50% of the patients in
dialysis units have type 2 diabetes. The explanation for the
increase in the number of patients with type 2 diabetes in
end-stage renal disease programs is not completely clear, but the
overall number of patients with this type of diabetes is rapidly
increasing - and is expected to continue to increase over the next
years.
The
diagnosis of renal disease in type 2 diabetes is usually
straightforward, and is mainly dependent upon measurements of
urinary albumin or urinary protein excretion as well as serum
creatinine measurements. Renal biopsies or exact glomerular
filtration rate measurements are rarely necessary.
Microalbuminuria is the first sign of renal disease in diabetes.
It predicts overt nephropathy and cardiovascular disease. Several
studies document that albuminuria and microalbuminuria can be
reduced by treatment with antihypertensives, especially agents
that block the renin angiotensin system. New studies show that
end-stage renal disease can be postponed by the use of angiotensin
II receptor antagonists. ACE inhibitors are also useful, and dual
blockade of the renin angiotensin system has been utilized as
well.
However,
generally speaking, patients with proteinuria have a poor
prognosis. Screening for microalbuminuria is therefore proposed,
and glycemic control and blood pressure should be optimized.
Treatments in Endocrinology Vol. 1 no 1 pp 3-11
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DID YOU KNOW?
According to
a study in the recent Diabetes Educator, most patents have not
been educated on the safe disposal of syringes and lancets. At
your next education session try to educate your patients on the
proper disposal procedures.
By referring
your friends and colleagues to Diabetes in Control you can win a
free scholarship or expense check for the 2002 AADE conference in
Philadelphia.
http://www.diabetesincontrol.com/scholorship.shtml
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