How to prevent the microvascular complications of type 2 diabetes beyond glucose control

Valencia, Willy Marcos; Flórez, Hermes

doi:10.1136/bmj.i6505

Cited by 166 publications

(121 citation statements)

References 126 publications

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“…Diabetes affects 30.3 million people of all ages representing 9.4% of US population [1] and about 149 million people and 10.9% of the population in China [2] and 415 million worldwide [3]. DKD is the most common cause of the ESRD in the world, and it is associated with increased morbidity and mortality in diabetic patients [4]. Although the incidence rate of chronic kidney disease (CKD) in diabetic patients has decreased in recent years in the US, the prevalence remains high.…”

Section: Good and Bad News In The Dkd Epidemiologymentioning

confidence: 99%

Diabetic Kidney Disease: Challenges, Advances, and Opportunities

et al. 2020

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Background: Diabetic kidney disease (DKD) is the most common cause of the end-stage renal disease (ESRD). Regardless of intensive treatments with hyperglycemic control, blood pressure control, and the use of renin-angiotensin system blockades, the prevalence of DKD remains high. Recent studies suggest that the spectrum of DKD has been changed and many progresses have been made to develop new treatments for DKD. Therefore, it is time to perform a systemic review on the new developments in the field of DKD. Summary: Although the classic clinical presentation of DKD is characterized by a slow progression from microalbuminuria to macroalbuminuria and by a hyperfiltration at the early stage and progressive decline of renal function at the late stage, recent epidemiological studies suggest that DKD patients have a variety of clinical presentations and progression rates to ESRD. Some DKD patients have a decline in renal function without albuminuria but display prominent vascular and interstitial fibrosis on renal histology. DKD patients are more susceptible to acute kidney injury, which might contribute to the interstitial fibrosis. A large portion of type 2 diabetic patients with albuminuria could have overlapping nondiabetic glomerular disease, and therefore, kidney biopsy is required for differential diagnosis for these patients. Only a small portion of DKD patients eventually progress to end-stage renal failure. However, we do not have sensitive and specific biomarkers to identify these high-risk patients. Genetic factors that have a strong association with DKD progression have not been identified yet. A combination of circulating tumor necrosis factor receptor (TNFR)1, TNFR2, and kidney injury molecular 1 provides predictive value for DKD progression. Artificial intelligence could enhance the predictive values for DKD progression by combining the clinical parameters and biological markers. Sodium-glucose co-transporter-2 inhibitors should be added to the new standard care of DKD patients. Several promising new drugs are in clinical trials. Key Messages: Over last years, our understanding of DKD has been much improved and new treatments to halt the progression of DKD are coming. However, better diagnostic tools, predictive markers, and treatment options are still urgently needed to help us to better manage these patients with this detrimental disease.

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Section: Good and Bad News In The Dkd Epidemiologymentioning

confidence: 99%

Diabetic Kidney Disease: Challenges, Advances, and Opportunities

et al. 2020

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“…32 In contrast, the prevention of macrovascular events has been addressed by targeting other CV risk factors, particularly hyperlipidaemia and hypertension, with a major emphasis on the use of ACE inhibitors, angiotensin-receptor blocking drugs and statins. 33 The results of the CV outcome trials discussed in this article offer exciting new possibilities.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular outcome trials in diabetes: what have we learnt?

Kirby

Boon

2018

Trends Urol & Men's Health

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“…Management of DKD and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors is beneficial for treating hyperglycemia and hypertension. However, DKD remains the leading cause of end-stage kidney disease (ESKD) worldwide (1)(2)(3). A decline in the glomerular filtration rate (GFR) and albuminuria are the predominant clinical features of DKD (4,5).…”

Section: Introductionmentioning

confidence: 99%

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

et al. 2019

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Objective: This study aimed to identify the risk factors for a rapid decline in the estimated glomerular filtration rate (eGFR) in Chinese patients with type 2 diabetes and biopsy-proven diabetic kidney disease (DKD). Method:This was a retrospective cohort study. Patients with biopsy-proven DKD who had been followed-up for at least 1 year were enrolled. Baseline clinicopathological data and serum creatinine levels that had been measured at least three times during follow-up in our hospital were collected. Patients were allocated to two groups of rapid decliners and slow decliners according to the median eGFR slope. The associations between potential risk factors and rapid eGFR decline were analyzed using logistic regression.Results: A total of 128 eligible patients were enrolled and they had a mean age of 51.5 ± 10.7 years. During a median follow-up of 2 years, the median eGFR slope was −8.1 ± 14.4 mL/min/1.73 m 2 /year. The eGFR decline was significantly faster in patients with a family history of diabetes in first-degree relatives, nephrotic-range proteinuria, higher grades of glomerular pathology, and interstitial inflammation. No differences in the rate of the eGFR decline were observed in subgroups created according to sex, age, hypertension, glycosylated hemoglobin, diabetic retinopathy, interstitial fibrosis, and tubular atrophy. Logistic regression indicated that a family history of diabetes was independently associated with a rapid decline in eGFR, even after adjustment for factors including baseline eGFR and proteinuria. Conclusion:A family history of diabetes in first-degree relatives is independently associated with a rapid decline in eGFR in the current relatively young studied patients. Our findings suggested that early diagnosis and treatment is important for these patients.

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How to prevent the microvascular complications of type 2 diabetes beyond glucose control

Cited by 166 publications

References 126 publications

Diabetic Kidney Disease: Challenges, Advances, and Opportunities

Diabetic Kidney Disease: Challenges, Advances, and Opportunities

Cardiovascular outcome trials in diabetes: what have we learnt?

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

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