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Retinopathy Common in Type 2 Diabetics A substantial number of adults with type 2 diabetes have chronic renal insufficiency without albuminuria or retinopathy, researchers report.
This finding has important implications for screening for renal disease in type 2 diabetics said, Dr. Holly J. Kramer of Loyola University Medical Center in Maywood, Illinois.
In a cross-sectional analysis of adults aged 40 or older with type 2 diabetes in the Third National Health and Nutrition Examination Survey, 13% had chronic renal insufficiency, defined as a GFR < 60 mL/min per 1.73 m of body surface area. That translates to a population estimate of 1.1 million Americans.
Among this group of type 2 diabetics with chronic renal insufficiency, 28% had diabetic retinopathy, while the frequencies of microalbuminuria and macroalbuminuria were 45% and 19%, respectively.
Dr. Kramer stated that, they noted the absence of increased urine albumin and diabetic retinopathy in 30% of adults with type 2 diabetes and chronic kidney disease." The population estimate of this group is approximately 0.3 million.
In the June 25th issue of The Journal of the American Medical Association, Dr. Kramer’s team says kidney disease in the absence of albuminuria and retinopathy is "likely due to renal parenchymal disease other than classic diabetic glomerulosclerosis."
"If physicians do not estimate the individual’s glomerular filtration rate in addition to examining urine albumin and diabetic retinopathy, approximately one-third of type 2 diabetics with chronic kidney disease will be missed," Dr. Kramer said.
"Unfortunately," she added, "many physicians" are not measuring serum creatinine levels or estimating glomerular filtration rate in addition to monitoring albumin excretion and funduscopic changes to screen for kidney disease in type 2 diabetics, despite recent National Kidney Foundation guidelines supporting this approach. JAMA 2003;289:3273-3277
DID YOU KNOW:
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