Diabetes

This graphic illustrates the concept of how better control can lead to fewer complications.

Variability in HbA1c may predict vascular events and reduction in renal function. (9)

In three reported studies by the Diabetes Control and Complications Trial (DCCT) Research Group and United Kingdom Prospective Diabetes Study, intensive control of blood glucose levels lead to significant reductions in retinopathy and other typical complications of diabetes.(9,10,11)

Progressive retinopathy

Albumineria has been associated with a reduction in renal function, and the graph above shows there is a decreased risk for those with intensive glycemic control.

Intensive glycemic control appears to have continuing benefits that may last years after involvement in such studies. For instance, reduced risk of neuropathy has been associated with glycemic control, which appears to have persistent benefits for patients who were a part of intensive glycemic control groups in studies compared to those with conventional control.(10)

Blood Pressure

◦<130/80 mmHg

•

•Blood Lipids

◦Total cholesterol: <180 mg/dl

◦LDL: <100 mg/dl

◦HDL: >40 mg/dl (men); >50 mg/dl

(women)

◦Triglycerides: <150 mg/dl

•

Secondary goals for patients with diabetes include control of blood pressure and blood fats. The treatments for diabetes can improve the outcomes in these areas, but there is sometimes a need to apply additional treatments, including medications to lower blood pressure and blood fats.

Nearly 75% of adults with diabetes have hypertension.(12) The American Diabetes Association and the National Institutes of Health recommend maintaining a lower blood pressure value than is recommended for people without diabetes at 130/80 mmHg. Hypertension in diabetes is treated the same way as it is without diabetes, through diet, exercise, smoking cessation, limiting alcohol and medications, as needed.

High blood pressure and diabetes are the most common reasons for kidney failure (according to the US Renal Data System USRDS 2007 Annual Data Report), accounting for more than 70%. Special care to maintain a target blood pressure (or lower) is an important part of the management of diabetic kidney disease.

Rick Fields-Gardner