Renal Protection in Diabetes
Open Access
- 1 April 2006
- journal article
- review article
- Published by Wolters Kluwer Health in Journal of the American Society of Nephrology
- Vol. 17 (4_suppl_2), S86-S89
- https://doi.org/10.1681/asn.2005121343
Abstract
Diabetes is the most common cause of ESRD in Western countries. This article describes the impact of glycemic control in the various stages of the disease and considers the impact of tight glycemic control on the development and progression of diabetic nephropathy (DN). The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetic Study have demonstrated in type 1 and type 2 diabetes that intensive glycemic control significantly reduces the risk for development of microalbuminuria. Although observational studies suggest an impact of glycemia also on the progression of DN, fewer data are available on the impact of improved metabolic control in secondary prevention. The long-term follow-up of the patients who participated in the Diabetes Control and Complications Trial (Epidemiology of Diabetes Interventions and Complications Study) demonstrated a sustained effect of previous tight glycemic control on both development and progression of DN. Finally, long-term normoglycemia, achieved by pancreas transplantation, is able not only to prevent the development of early diabetic glomerulopathy in kidney transplant recipients but also to halt progression and induce regression of the established diabetic renal lesions in nonuremic patients. Taken together, these studies strongly demonstrate that improvement in glucose control is the most important therapeutic approach in primary prevention. Tight glycemic control also is important in slowing progression of DN, and if blood glucose is normalized, then regression of DN can be achieved. Therefore, a target of glycated hemoglobin levels <7% should be recommended in all patients with diabetes.Keywords
This publication has 26 references indexed in Scilit:
- Progression of nephropathy in type 2 diabetic patientsKidney International, 2004
- Microalbuminuria in type 1 diabetes: Rates, risk factors and glycemic thresholdKidney International, 2001
- Progression of diabetic nephropathyKidney International, 2001
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998
- Glycemic Control and Prognosis in Type I Diabetic Patients With MicroalbuminuriaDiabetes Care, 1996
- Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications TrialKidney International, 1995
- Advanced Glycosylation End Products in Tissue and the Biochemical Basis of Diabetic ComplicationsNew England Journal of Medicine, 1988
- EFFECT OF TWO YEARS OF STRICT METABOLIC CONTROL ON PROGRESSION OF INCIPIENT NEPHROPATHY IN INSULIN-DEPENDENT DIABETESThe Lancet, 1986
- Studies of Kidney and Muscle Biopsy Specimens from Identical Twins Discordant for Type I Diabetes MellitusNew England Journal of Medicine, 1985