Diabetes has significant associated morbidity. There is a high rate of cardiovascular disease, resulting in an increased mortality rate among patients with diabetes compared to the general population. There are also microvascular complications, including retinopathy, nephropathy, and neuropathy, that can progress to end-stage outcomes such as blindness, renal failure, and amputation. Improving glycemic control decreases the incidence of microvascular disease, but the effect of glycemic control on cardiovascular disease remains uncertain. Minorities have a prevalence of type 2 diabetes mellitus that is 2 to 6 times greater than that of Caucasians. The morbidity and mortality are higher for minorities than for Caucasians, and the rate is increasing. Therefore, in minorities with diabetes, more aggressive management may be indicated.
Both forms of diabetes (type 1 & type 2) ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.The prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995 and is predicted to rise to 5.4% by the year 2025. It is higher in industrialized than in developing countries. The number of adults with diabetes in the world is forecast to rise from 135 million in 1995 to 300 million in the year 2025. Most of this increase will occur in developing countries.
Screening and treatment for early diabetic complications is effective in reducing the incidence of end-stage complications. However, implementation rates of recommended screening procedures are low, leading to ineffective and/or delayed treatment of complications. This, in turn, increases the costs of medical care and adversely affects quality of life.
Diabetic nephropathy is rapidly becoming the leading cause of end-stage renal disease (ESRD), particularly in the industrialized countries of the world. Ethnic and racial origin play an important role, resulting in increased prevalence rates of diabetic nephropathy in certain regions.The main causes of ESRD in Egypt other than diabetic nephropathy included hypertensive kidney disease, chronic glomerulonephritis, undetermined etiology, reflux and chronic pyelonephritis, schistosomal obstructive uropathy and schistosomal nephritis .Mortality among diabetic patients with ESRD is higher than in patients with ESRD from other causes.
Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nodular glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime cause for dialysis in many Western countries.
Looking at various proteins in urine may help doctors predict the development of diabetic nephropathy in type 2 diabetes patients well before they develop the condition, according to a report in the March Diabetes Care.
"We have identified a set of urine proteins almost 10 years before the onset of diabetic nephropathy that identify those who will go on to get diabetic nephropathy, the most common cause of renal failure in the U.S. and the world," Dr. Ravi Thadhani, from Massachusetts General Hospital and Harvard Medical School in Boston, told Reuters Health. Diabetic nephropathy is a serious complication of diabetes in which the kidneys lose their ability to function over time.
Thadhani and colleagues compared urinary protein profiles among 62 Pima Indians with type 2 diabetes and normal kidney function who were followed for 10 years for the development of diabetic kidney disease.
The authors identified a protein "signature" that proved highly predictive of the development of diabetic nephropathy and will be allowed to reduce or halt progression of diabetic kidney diseas.
"While these findings require a significant amount of work to identify and test the robustness of these markers, they offer the potential for clinicians one day to be able to tell whether a diabetic patient will get renal failure well before the development of this devastating condition, and, hence, offer hope for early intervention to prevent its onset," Thadhani said.
"First we need to confirm the identification of the proteins we uncovered, then we need to test this profile in other populations with type 2 diabetes to determine if the same predictive potential remains," Thadhani explained. "Then we will carry out prospective studies in larger populations."
Effective management of diabetes has many components which need to be addressed by clinicians. However, as diabetes is a largely self-managed disease, psychosocial and educational factors may affect outcomes. Therefore, these issues need to be addressed in detail to allow optimization of treatment and reduce the likelihood of adverse outcomes. Diabetes education should provide consistent, evidence-based teaching that conforms with treatment guidelines and patient goals.
Uncontrolled high blood pressure will worsen kidney, eye, and blood vessel damage in the body. Controlling your high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy. It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.
Blood glucose levels should be closely monitored and controlled. This may slow the progression of the disease especially in the very early stages. Your can change your diet to help control your blood sugar.
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