The prevalence of nephropathy (encompassing microalbuminuria, proteinuria and end-stage renal disease) is 48% in seven countries representing 18.6m type 2 patients. The main focus of therapy in diabetic nephropathy is on tight control of blood pressure and either ACE or ARB therapy is recommended as a first line renoprotective anti-hypertensive therapy. Existing anti-hypertensive therapies can however only delay the progression of diabetic nephropathy. Research elucidating the etiology and pathways of diabetic microvascular disease has revealed new targets for drug design. Within the next 10 years the most promising compounds will come from the ARI, PKC-beta and AGE inhibitor classes.
Intensive glycemic control prevents or retards microalbuminuria, an early sign of nephropathy, in patients with type 2 diabetes. In their April Quarterly Journal of Medicine journal article, Joss et al determine the effect of intensive vs. standard medical management over a two year period on the rate of progression of renal failure in patients with diabetic nephropathy. The Glasgow Royal Infirmary group's prospective randomized controlled study divided patients with type 2 diabetes and nephropathy into an intensive group (n = 47) or control group (n = 43). Treatment targets were the same for both groups, but the intensive group were seen as often as required to meet the targets. The primary end-point was the rate of progression of renal disease in the second year.
The results of this study demonstrate that during follow-up, the intensive group had lower mean systolic and diastolic blood pressures as well as cholesterol levels. Median rate of progression of renal failure in the intensive group fell from 0.44 ml/min/month in the first year to 0.14 ml/min/month in the second year, compared to 0.49 ml/min/month and 0.53 ml/min/month in the control group. Patients in the intensive group spent significantly less time in hospital.
This important study highlights the benefits of intensive treatment as this approach both limited co-existent hypertension and slowed progression of renal disease within 2 years in patients with established diabetic nephropathy. Indeed the authors predict that onset of dialysis would be delayed by 20 years in the intensive group compared with the control group.
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Last updated on: 27/08/2010 11:40:18
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