Prevention of Diabetic Nephropathy by Tight Target Control in an Asian Population With Type 2 Diabetes Mellitus

Tu, Shih‐Te; Chang, Shun‐Jen; Chen, Jung‐Fu; Tien, Kai Jen; Hsiao, Jeng-Yueh; Chen, Hung‐Chun; Hsieh, Ming‐Chia

doi:10.1001/archinternmed.2009.471

Cited by 55 publications

(38 citation statements)

References 24 publications

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“…Although longer T2DM duration was seen in the DN patients versus normoalbuminuric patients (with macroalbuminuric patients having lower disease duration than microalbuminuric patients), it did not attained statistical significance (p = 0.052), conflicting with previous findings [57][58][59] that longer T2DM duration increases the risk of DN development. However, in our study univariate analysis revealed that in addition to ACE genotype, significantly higher HbA1c [59][60][61], and creatinine levels [58,59,61] were associated with renal injury, in accord with other studies on DN development.…”

Section: Discussionsupporting

confidence: 91%

Genetic Predisposition to Diabetic Nephropathy: Evidence for a Role of ACE (I/D) Gene Polymorphism in Type 2 Diabetic Population from Kutch Region

et al. 2013

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Genetic polymorphism as described with angiotensin-converting enzyme gene has been proposed as a putative mediator of diabetic nephropathy. We substantiate the hypothesis that genetic variants of the ACE have significant impacts on diabetic nephropathy. To assess the possible association between the three ACE polymorphic variants and DN in an ethnically homogeneous type 2 diabetic population from Kutch region. A 287-bp insertion/deletion polymorphism in intron 16 of the ACE gene was examined by polymerase chain reaction using a case-control approach conducted with 309 unrelated type 2 diabetic patients of Kutch origin (159 Ahir and 150 Rabari, with [10 years duration of T2DM). Of the patients, 143 had nephropathy {AER[30 mg/day (Ahir, n:73 and Rabari, n:70)} and were considered as cases; all others {n:166 (86 Ahir and 80 Rabari)} were normoalbuminuric (AER\30 mg/day) and were treated as controls. Suitable descriptive statistics was used for different variables. Genotype frequencies in all groups were all in accordance with the Hardy-Weinberg equilibrium. Genotypic distribution was significantly different between cases and controls (Ahir: x 2 :8.87, 2 d.f. p = 0.0118; Rabari: x 2 :11.01, 2 d.f. p = 0.0041). Multivariate logistic regression analysis revealed that DD genotype was a significant and strongest independent predictor of microalbuminuria (Ahir: p = 0.0362, OR = 2.65, 95 % CI 1.89-6.36; Rabari: p = 0.024, OR = 2.81, 95 % CI 1.9-6.65). However, it did not independently change the odds of having macroalbuminuria versus microalbuminuria. Analysis of the association under various genetic models revealed that ACE I/D polymorphic variant contribute to DN susceptibility under recessive mode only. Genetic variation at the ACE locus as D/D variant in intron 16, contribute to an increased risk of nephropathy in T2DM patients but not extent of DN severity, and thus this polymorphism might be considered as genetic risk factors for DN among patients with type 2 diabetes.

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Section: Discussionsupporting

confidence: 91%

Genetic Predisposition to Diabetic Nephropathy: Evidence for a Role of ACE (I/D) Gene Polymorphism in Type 2 Diabetic Population from Kutch Region

et al. 2013

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“…13,14 Therefore, early intensive glycemic and blood pressure control can effectively prevent the occurrence of diabetic nephropathy. 15 The presence of peripheral neuropathy, PVD, and poor glycemic control in conjunction with minor foot trauma increases the likelihood that patients with diabetes will develop foot ulcers. 16 Ulcers, in turn, often progress to infections of the surrounding tissues, osteomyelitis, gangrene, and amputation.…”

Section: Discussionmentioning

confidence: 99%

Diabetes-related kidney, eye, and foot disease in Taiwan: An analysis of the nationwide data for 2000–2009

Huang

Lin

Yin

et al. 2012

Journal of the Formosan Medical Association

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“…In keeping with the multicausality of chronic kidney disease, attainment of multiple treatment goals in blood pressure, glucose and lipid control and blockade of the RAAS was associated with increased probability of remission, and reduced probability of progression of diabetic albuminuria [40,41]. In a multicentre randomized study involving 205 Chinese type 2 diabetic patients with renal insufficiency, patients treated with structured care delivered by a doctornurse team were 3-fold more likely to attain multiple treatment goals compared to usual care (61 vs. 28%).…”

Section: Multifactorial Treatment To Prevent Diabetic Nephropathymentioning

confidence: 99%

Treatment and Landmark Clinical Trials for Renoprotection

Ting¹,

Luk²,

Chan³

2011

Contributions to Nephrology

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During the last two decades, many large-scale randomized clinical trials have confirmed the importance of lowering blood pressure and inhibiting the renin-angiotensin-aldosterone system (RAAS) to preserve renal function in patients with chronic kidney disease due to different causes. With growing epidemic of type 2 diabetes, the burden of diabetic nephropathy (DN) will continue to grow. Based on a large body of epidemiological, experimental and interventional studies, strict glycemic control, blood pressure lowering and RAAS blockade are now the recommended strategies in the prevention and control of DN. Both angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) have been shown unequivocally to reduce proteinuria and preserve renal function in affected patients. Importantly, therapeutic responses are dose dependent, and these drugs should be given in maximal dosages as tolerated. Combined use of ACEI and ARB reduced proteinuria and rate of decline of renal function, although it did not appear to confer extra renoprotection over the use of either agent alone. Spironolactone and aliskiren are alternative drugs that block the RAAS and have been demonstrated to further reduce proteinuria when added to ACEI or ARB. In the absence of long-term data about their safety and efficacy on renal function, combined use of these agents must be administered with caution after careful consideration of risk-benefit ratio with close monitoring for adverse effects, notably hyperkalemia. Pending further evidence, the use of a team approach to attain multiple treatment goals will improve renal outcomes in these high risk subjects.

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Prevention of Diabetic Nephropathy by Tight Target Control in an Asian Population With Type 2 Diabetes Mellitus

Abstract: Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADA-recommended targets. This multifactorial intervention should be started in patients with diabetes and normoalbuminuria.

Cited by 55 publications

References 24 publications

Genetic Predisposition to Diabetic Nephropathy: Evidence for a Role of ACE (I/D) Gene Polymorphism in Type 2 Diabetic Population from Kutch Region

Genetic Predisposition to Diabetic Nephropathy: Evidence for a Role of ACE (I/D) Gene Polymorphism in Type 2 Diabetic Population from Kutch Region

Diabetes-related kidney, eye, and foot disease in Taiwan: An analysis of the nationwide data for 2000–2009

Treatment and Landmark Clinical Trials for Renoprotection

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