Nephrol Dial Transplant (2003) 18: 1711-1715
© 2003 European Renal Association-European Dialysis and Transplant Association
Invited Comment
Hyperglycaemia in diabetes: impact on nephropathy and cardiac risk
Department of Medicine, University Hospital of Lund, Sweden
Correspondence and offprint requests to: Ole Torffvit, Department of Medicine, University Hospital of Lund, S-22185 Lund, Sweden. Email: ole.torffvit@med.lu.se
Keywords: cardiac risk; diabetes; hyperglycaemia; nephropathy
| The first 150 words of the full text of this article appear below. |
Introduction
In the past there has been much discussion whether improved control of hyperglycaemia translates into better cardiovascular and renal outcomes. Today this has been proven both for type 1 diabetes in the DCCT (Diabetes Control and Complications Trial) [1] as well as for type 2 diabetes by the Kumamoto trial [2] and UK-PDS study (United Kingdom Prospective Diabetes Study), respectively [3]. It has also become clear, however, that important though hyperglycaemic control is, it is absolutely necessary to use an integrated approach controlling the entire spectrum of risk factors such as hypertension, smoking, dyslipidaemia, etc. [4].
The urgency of intervention is illustrated by our own 10 year observational study: mortality was 14% in type 1 and 33% in type 2 diabetic patients with microalbuminuria; it was even higher, i.e. 38% for type 1 and 73% for type 2 diabetic patients with macroalbuminuria
Integrated treatment approach
Metabolic control and progression of renal disease
Improved glycaemic control: the role of intensified traditional insulin treatment
How to prevent hyperinsulinaemia and restore the early rise of plasma insulin?
Glycaemic control: new insulin types
Oral hypoglycaemic agents, e.g. sulfonylureas and metformin
Conclusions and recommendations