The dramatic increase in the number of patients with diabetes mellitus (DM) and chronic renal disease (CRD) in the recent years emphasizes the closeassociation between the two conditions and the leading role of DM in the development of renal pathology. Diabetology and nephrology are highly costlybranches of public health, and the burden of substitution renal therapy in DM patients continues to grow. The necessity of a renoprotection programat the early stages of DM for the prevention or delay of terminal renal insufficiency becomes increasingly clear. Such program should be based on theconceptual model of the evolvement of diabetic nephropathy as a consequence of combined action of metabolic and hemodynamic factors modulatedby genetic ones.
Frequency of the diabetes mellitus (DM) and chronic kidney disease (CKD) steadily increases around the world. Compensation of a carbohydrate metabolism plays a key role in prevention of development and progressing of CKD in patients with DM, that was proved in the largest researches. However at later stages of CKD compensation of a carbohydrate metabolism is extremely complicated because of high risk of hypoglycemia due to decrease in a renal gluconeogenesis, insulin and anti-hyperglycemic agents cumulation, inadequate level of glycated hemoglobin due to nephrogenic anemia. Thus, great care and an individual approach in choosing and intensification of hypoglycemic therapy are required in patients with diabetes. Incretin drugs have taken a worthy place in the international and national guidelines for the treatment of patients with type 2 diabetes mellitus (DM2). Inhibitors of dipeptidyl peptidase-4 (DPP-4) showed a favorable efficacy and safety profile in patients with normal renal function and patients with CKD.
Cardiovascular complications, a major cause for disability and morbidity in diabetes mellitus (DM), constitute the greatest threat of the diabetes epidemic. Glycemic stability within the therapeutic targets is a prerequisite to prevention of micro- and macrovascular complications of DM. Traditional therapies are aimed at cardinal defects determining development of type 2 diabetes mellitus (T2DM). Unfortunately even in combination they fail to deliver long-term glycemic control without stimulation of weight gain and increase in hypoglycemic risks with negative cardial, renal and hepatic impact. Preservation of beta-cell secretion capacity is also hardly attainable. Incretin-based therapy is a novel, actively developed approach that influences gut hormone physiology for better glycemic control. So far research efforts have yielded two classes of drugs: GLP-1 mimetics and DPP-4 inhibitors. Both are regarded nowadays for a number of important benefits, including beta-cell function improvement, adjusted to human physiology (i.e. stimulation of insulin secretion ?as needed? by the body, - hence low hypoglycemic risk). They also feature positive cardiovascular and body weight effects, thereby taking an important position in complex DM treatment.
Aim. To study the prevalence of renal lesions in adult patients with type 1 and 2 diabetes mellitus in the Russian Federation. Materials and methods. A total of 7174 patients with DM1 and DM2 were examined in 20 regions of the Russian Federation for blood HbA1c creatinine,urea, and cholesterol levels, albumin excretion in a single urine sample, AP, and eye fundus condition. Albumin concentration from 20 to 200mg/l was regarded as microalbuminuria (MAU) that above 200 mg/l as proteinuria (PU). The glomerular filtration rate (GFR) was calculated fromCockroft-Gault formula. Statistica-6 program was used for statistical treatment of the results of the study. They are represented as median, 25th and75th percentile values (Me [25%;75%]). Differences between all parameters is considered significant at p
Expansion of diabetic population (predominantly due to type 2 diabetes mellitus) with chronic kidney disease (CKD) comorbidityconstitutes one of the major challenges in modern medicine.Throughout the course of diabetes nephropathy development, from its debut to the terminal stage, survival rate and quality of life arelower than those of other categories of patients. This indicates crucial role of hyperglycemia in accelerated metabolic degradation typicalof CKD.Renal disease severely narrows the spectrum of available glucose-lowering agents. Concurrent treatment for hypertension and dyslipidemia,as well as anti-platelet therapy and stimulation of erythropoiesis becomes a complex issue. A creative and patient-orientedapproach with clear metabolic and cardiovascular goals should be instrumental in its solution.
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