Treatment & Prevention > Microvascular Complications |
Treatment and Prevention of Diabetic Nephropathy
Diabetic nephropathy occurs in 20% to 40% of all patients diagnosed with diabetes and is the single leading cause of end-stage renal disease (ESRD), accounting for more than 40% of new cases. Persistent albuminuria in the range of 30 to 299 mg/24 h (microalbuminuria) has been shown to be the earliest stage of diabetic nephropathy in Type 1 diabetes and a marker for development of nephropathy in Type 2 diabetes. Intensive diabetes management and blood pressure control significantly reduce the progression of nephropathy. The primary focus of this article is to summarize the current treatments for diabetic nephropathy and emphasize the importance of early prevention.
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Treatment and Prevention of Diabetic Neuropathy
Diabetic Neuropathy is evident in about 50% of patients diagnosed with diabetes and is the most common complication of diabetes. Diabetic neuropathy is the most common form of neuropathy in developed countries and is responsible for 50% to 70% of nontraumatic lower-limb amputations. The primary risk factor for developing diabetic neuropathy and progression of neuropathy is hyperglycemia while the treatment and prevention of neuropathy first begins with achieving glycemic control. Pharmacologic therapy can be initiated with the goals of reducing symptoms and preventing the progression of diabetic neuropathy. The intent of this article is to summarize available information concerning the treatment and prevention of each classification of diabetic neuropathy.
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Managing Diabetic Neuropathy in Primary Care
Evidence indicates that diabetic neuropathy is a direct consequence of persistent hyperglycemia, and that prevention is paramount: once it occurs, neuropathic damage is not reversed by current treatments, and symptomatic palliation remains a therapeutic challenge.
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Treatment and Prevention of Diabetic Retinopathy
Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 20-74 years, causing blindness in more than 12,000 to 24,000 people each year and is strongly related to the duration of diabetes. During the first two decades of disease, nearly all patients with Type 1 and >60% of patients with Type 2 diabetes develop diabetic retinopathy. Up to 21% of patients with Type 2 diabetes have retinopathy at the time of first diagnosis. The most common factors contributing to the development of diabetic retinopathy include hyperglycemia, hypertension, and hypercholesterolemia. However, there are available therapies designed to help the clinician treat and/or prevent diabetic retinopathy.
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Treating Diabetic Nephropathy in Primary Care
Diabetic nephropathy has been categorized into two stages based on the degree of urinary albumin excretion (UAE): microalbuminuria and macroalbuminuria. Microalbuminuria is both a predictor of progression of nephropathy and an independent risk factor for cardiovascular disease (CVD), and evidence to date suggests that the risk for developing diabetic nephropathy and CVD begins when UAE values are still within the normoalbuminuric range. In addition, patients that do not receive effective treatment for diabetic nephropathy can experience renal failure, leading to end-stage renal disease (ESRD).
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