Cardiovascular Risk Factors and Disease Management in Type 2 Diabetic Patients With Diabetic Nephropathy

Abstract

OBJECTIVE -The purpose of this study was to assess the prevalence of cardiorenal risk factors, their management in a routine clinical setting, and the actual achievement of international guideline targets in a large cohort of type 2 diabetic patients with diabetic nephropathy.RESEARCH DESIGN AND METHODS -A multicentric cross-sectional study was performed in the Campania region in Italy to evaluate cardiorenal risk factors and their management in light of international guidelines. Overall, 28,550 diabetic patients were screened in the 21 participating centers; 847 (348 male and 449 female) patients with type 2 diabetes and a clinical diagnosis of diabetic nephropathy were recruited.RESULTS -Of these subjects, 749 had microalbuminuria and 98 had macroalbuminuria. Targets for blood pressure, HbA 1c , LDL cholesterol, HDL cholesterol, and triglycerides were reached in, respectively, 17.5, 32.3, 30.7, 47, and 55.2% of the patients. Chronic renal failure (glomerular filtration rate Ͻ60 ml/min) was revealed in 41% and anemia in 23.8% of the patients.CONCLUSIONS -This is the first study to investigate a large cohort of type 2 diabetic patients with early and moderate diabetic nephropathy strictu sensu. Notably, impaired renal function can be often diagnosed in these patients even in the presence of microalbuminuria. Thus, clinical diagnosis of diabetic nephopathy allows us to identify a group of patients at very high cardiorenal risk, for whom care is really difficult. We suggest that a correct diagnosis of diabetic nephropathy should always be made and that sodium intake and anemia should be routinely evaluated in these patients. Diabetes Care 29:498 -503, 2006D iabetic nephropathy in patients with type 2 diabetes has a cumulative prevalence of 30 -40% (1) and is currently the leading cause of end-stage renal disease (ESRD) in Western countries. Diabetic patients with renal damage are at higher risk of fatal and nonfatal cardiovascular events (1), and, as a consequence, diabetic nephropathy has also become an economic issue (2).Epidemiological studies have demonstrated that the factors strictly correlated to the progression of nephropathy in diabetic patients are arterial blood pressure, glycemic control, lipid levels, proteinuria levels, obesity, anemia, and cigarette smoking, with most of these critically influencing mortality (3,4). Nevertheless, what is emerging is the fact that physicians must treat the global cardiovascular risk rather than a single risk factor to achieve maximal renal and cardiovascular protection. Consequently, the number and strictness of the targets have increased, together with the difficulty of reaching them.Data from interventional studies in type 2 diabetic populations with overt (5,6) or also early nephropathy (7), who are expected to have a very high prevalence of cardiovascular risk factors (8), indirectly suggest that new targets are hard to achieve even in the groups receiving intensive therapy. However, no study has specifically evaluated the implementation of guidelines in patients...

Cardiovascular Risk Assessment in Diabetes and Chronic Kidney Diseases: A New Insight and Emerging Strategies

“…Despite medications and attempts to control these CV risk factors, CV events still remain the most www.intechopen.com common cause of mortality both in DM and in ESRD [47][48][49]. While a greater risk of CV events is expected in DM compared to non-DM patients with ESRD , the available reports regarding the risk profile in DM and non-DM patients with ESRD are conflicting [42,43,[50][51][52][53]. Likewise interactions between ESRD and DM in the development and progression of arterial stiffness are not completely clear [54,55].…”

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Role of Adiponectin in Development and Progression of Diabetic Complications

“…Adiponectin-dependent AMPK activation in skeletal musclewas associated with an increase in ACC phosphorylation and a decrease in the concentration of malonyl-CoA [52,50] . Malonyl-CoA is an allosteric inhibitor of carnitinepalmitoyltransferase 1 (CPT-1), an enzyme responsible for the transport of fatty acids into mitochondria, where fatty acid oxidation occurs [57] . Thus a decrease in malonyl-CoA concentration after adiponectin treatment may be the reason for increased fatty acid oxidation in muscle [50] .…”

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“…Other disorders which tea can play a role in prevention or treatment of, includes inflammation, migraine, nausea, diarrhea, maldigestion, sore throat, depression, prostatitis, hemochromatosis, neurodegenerative diseases like Parkinson and Alzheimer, cataract, dental carries and some viral and bacterial infections including influenza, polio, herpes simplex and AIDS (Duke, 1985;Robertson et al, 1991;Hertog et al, 1993;Cummings et al, 1995;Tavani et al, 1996;Van Het Hof et al, 1997;Integrative Medicine, 2000;Mills et al, 2000;McKay et al, 2002;Wright, 2005;Kao et al, 2006;Sasso et al, 2006;Alipoor et al, 2011).…”