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Battling CKD in Patients with Diabetes

This Physician’s Weekly feature on chronic kidney disease and diabetes was completed in cooperation with the experts at the American Diabetes Association. Each year in the United States, more than 100,000 people are diagnosed with kidney failure, and diabetes is the most common cause of it, accounting for nearly 44% of new cases. Even when diabetes is controlled, it can lead to chronic kidney disease (CKD) and kidney failure. “According to current estimates, about 20% to 30% of people with diabetes have at least some CKD, although not necessarily end-stage renal disease,” explains M. Sue Kirkman, MD. “More patients with diabetes also have very early signs of kidney damage, such as microalbuminuria. Fortunately, we now have interventions to help prevent early CKD from progressing or worsening in people with diabetes.” Diabetic kidney disease takes many years to develop. In some patients, the filtering function of the kidneys is higher than normal in the first few years of the development of diabetes. Over several years, patients may develop low levels of albuminuria—termed microalbuminuria—but the kidneys’ filtration function usually remains normal during this period. Greater amounts of albuminuria (macroalbuminuria) occur in parallel with the kidneys’ filtering function declining, forcing the body to retain various wastes along the way. As kidney disease progresses, physical changes in the kidneys can increase blood pressure. As such, early detection and treatment of even mild hypertension are essential for people with diabetes. Early Screening is Imperative The American Diabetes Association recommends that every patient diagnosed with diabetes be screened for CKD (Table 1). “It’s better to diagnose it early and address problems at that time rather...

American Diabetes Association 2010 Scientific Sessions

The American Diabetes Association held its 2010 Annual Scientific Sessions from June 25 to 29 in Orlando. The features below highlight some of the news emerging from the meeting. » Investigational Drug Effective as Metformin Add-On » Minor Kidney Damage in Type 1 Diabetes Increases Mortality » The Impact of Exercise Alone on Diabetes Risk » Omega-3 Fatty Acids, Women, & Type 1 Diabetes » Diabetes A Common Cause of Vascular Death Investigational Drug Effective as Metformin Add-On [back to top] The Particulars: Dapagliflozin is an investigational selective sodium-glucose cotransporter-2 inhibitor. Dapagliflozin is thought to reduce renal glucose reabsorption so that excess blood glucose is instead excreted into the urine. The mechanism of action is independent of insulin. A phase III trial was conducted in metformin patients who had not achieved adequate glucose control. Data Breakdown: All patients were randomized to placebo or one of three doses of dapagliflozin (2.5 mg, 5.0 mg, or 10.0 mg), and patients also continued taking metformin. Mean glycosylated hemoglobin decreased significantly for patients on any of the three doses of dapagliflozin when compared with those on placebo. At 24 weeks, more patients in the dapagliflozin groups achieved a therapeutic response, which was defined as A1C levels of less than 7% (33% to 40.6% in dapagliflozin groups vs 25.9% in controls). Decreases in fasting plasma glucose concentration and weight loss were also significantly greater in the dapagliflozin groups when compared with placebo. Take Home Pearls: Adding dapagliflozin to metformin may improve glycemic control in patients with diabetes who are not responsive to metformin monotherapy. The addition of dapagliflozin to metformin may provide a new...
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