The relationship between glucose control and the development and progression of diabetic nephropathy.
Diabetic nephropathy is a major cause of morbidity and mortality in patients with diabetes; it occurs in about one third of such patients. The course of nephropathy is better defined and similar for both type 1 and type 2 diabetes. Patients initially develop microalbuminuria (albumin excretion rates [AERs] between 20 and 200 micrograms/min), then overt nephropathy (AER > or = 200 micrograms/min), and finally a decline in glomerular filtration rate (GFR) eventuating in end-stage renal disease. Although metabolic control has long been hypothesized as a contributor to the development of nephropathy, it is only in recent years that this hypothesis has been proven. A number of observational studies have shown correlations between glycemic control and the development of various levels of albuminuria and also declines in GFR. However, large long-term prospective, randomized, interventional studies have now definitely proven that improved metabolic control that achieves near-normoglycemia can significantly decrease the development and progression of diabetic nephropathy as well as other long-term complications of diabetes, including retinopathy and neuropathy. It is now conceivable that the achievement of near-normoglycemia, plus medications that inhibit the renin-angiotensin system if microalbuminuria develops, may greatly decrease the numbers of patients eventually requiring renal replacement therapy.
Phillips
Carrie A
CA
Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine of Northwestern University, 303 E. Chicago Avenue (Tarry 15-731), Chicago, IL 60611, USA.
Molitch
Mark E
ME
D001786:Blood Glucose; D003928:Diabetic Nephropathies / Q000097:blood* / Q000503:physiopathology*; D018450:Disease Progression; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology* / Q000628:therapy*
D001786:Blood Glucose