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Preventing Diabetes Complications to Improve Outcomes

More than 84 million people in America have diabetes or are on the verge of getting it, and 90% of these people have type 2 diabetes. Between 2002 and 2007, the cost of diabetes-related complications to the United States healthcare system more than doubled from $24.6 billion to $58 billion. In many cases, type 2 diabetes can be managed or avoided with lifestyle changes like weight loss and exercise. Unfortunately, many people with type 2 diabetes struggle to find the motivation needed to make these changes. As a result, they are experiencing life-altering complications such as heart attack, stroke, blindness, limb amputation, and kidney failure at alarming rates. New Survey Data A survey commissioned by Boehringer Ingelheim Pharmaceuticals and conducted by Sermo recently convened a multidisciplinary steering committee to assess attitudes about diabetes-related complications. It showed that complications are prevalent in type 2 diabetes. More than 40% of physicians surveyed said that over half of their patients develop at least one complication as a result of uncontrolled type 2 diabetes. Nearly all physicians surveyed (94%) believed that kidney health is an important consideration in understanding the risk of other complications, but 40% did not believe the majority of their newly diagnosed patients even know that type 2 diabetes can lead to kidney disease. “To reduce the disease burden, complications related to type 2 diabetes must be decreased.” Physicians participating in the survey reported that lack of motivation, lack of medication adherence, and an inability to lose weight were the most common reasons for ineffective control of their patients’ type 2 diabetes. Compliance with lifestyle modifications and medications and poor...

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...
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