Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study
ABSTRACT In type 2 diabetes mellitus the aetiology of long-term complications is multifactorial. We carried out a randomised trial of stepwise intensive treatment or standard treatment of risk factors in patients with microalbuminuria.
In this open, parallel trial patients were allocated standard treatment (n=80) or intensive treatment (n=80). Standard treatment followed Danish guidelines. Intensive treatment was a stepwise implementation of behaviour modification, pharmacological therapy targeting hyperglycaemia, hypertension, dyslipidaemia, and microalbuminuria. The primary endpoint was the development of nephropathy (median albumin excretion rate >300 mg per 24 h in at least one of the two-yearly examinations). Secondary endpoints were the incidence or progression of diabetic retinopathy and neuropathy.
The mean age was 55.1 years (SD 7.2) and patients were followed up for 3.8 years (0.3). Patients in the intensive group had significantly lower rates of progression to nephropathy (odds ratio 0.27 [95% CI 0-10-0.75]), progression of retinopathy (0.45 [0.21-0.95]), and progression of autonomic neuropathy (0.32 [0.12-0.78]) than those in the standard group.
Intensified multifactorial intervention in patients with type 2 diabetes and microalbuminuria slows progression to nephropathy, and progression of retinopathy and autonomic neuropathy. However, further studies are needed to establish the effect of intensified multifactorial treatment on macrovascular complications and mortality.
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ABSTRACT: T he title of this editorial is the slogan given by the International Diabetes Federation (IDF) and World Health Organisation (WHO) as the theme of this year's World Diabetes Day to draw the attention of the physicians and the patients towards the consequences of diabetic nephropathy, encourage early detection and evaluation and try to prevent what is essentially a preventable disease. Diabetic nephropathy is clinically defined by the presence of persistent proteinuria of > 500 mg/day in a diabetic patient who has concomitant diabetic retinopathy and hypertension and in the absence of clinical or laboratory evidence of other kidney or renal tract disease. Nearly 30% of chronic renal failures in India are due to diabetic nephropathy. The prevalence of diabetic nephropathy in type 2 diabetic subjects is reported to be 5-9% from various Indian studies. 2-4 Racial differences in the prevalence of diabetic renal disease have been reported. In a recent study by Young et al, 5 it was observed that Asian subjects had significantly (p < 0.01) higher prevalence (52.6%) of diabetic end-stage renal disease (ESRD) when compared with the Caucasians (36.2%). Recently, Shaw et al showed that migrant Asian Indians had 40 times greater risk of developing ESRD when compared with the Caucasians. 6
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ABSTRACT: Diabetic kidney disease (DKD) is a progressive condition and is an important cause of end-stage renal disease (ESRD) causing increased morbidity and mortality. The objective of this review article is to discuss about recognition and treatment of early DKD to prevent its progression. Informations have been gathered from related clinical studies, research works, articles, abstracts, and guidelines of different organizations published in various journals. Microalbuminuria describes the urinary excretion of small amounts of albumin which identifies the early stage of DKD. In addition to an earliest marker of kidney damage, microalbuminuria is an established high risk factor for cardiovascular morbidity and mortality. Patients with microalbuminuria who progress to macroalbuminuria are likely to progress to ESRD. There is general agreement that people with diabetes should be screened regularly to detect early markers of kidney damage. Albumin creatinine ratio in a morning urine sample is the preferred method of detecting microalbuminuria in diabetes. There is strong evidence that a number of interventions if initiated at early stage of DKD reduces the risk and slows the progression of kidney damage. People with diabetes and microalbuminuria should be treated with a multifactorial intervention approach to retard the progression of DKD. Studies have clearly demonstrated that the use of angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers with improved glycemic control, blood pressure control, lipid lowering, aspirin, smoking cessation, exercise programs and dietary intervention reduced the development of overt nephropathy and ESRD.01/2014; Vol. 2(No. 2):26-33. DOI:10.11648/j.ajim.20140202.14