Preventing Occurrence of Microalbuminuria in Type 2 Diabetes

Data presented at Renal Week 2009 demonstrate that an angiotensin receptor blocker—olmesartan—appears to provide vascular protection in patients with type 2 diabetes by controlling blood pressure and delaying the occurrence of microalbuminuria. According to the World Health Organization, about 170 million people in the world had diabetes in 2000, and that figure is expected to double within the next 20 years. The most prevalent form—type 2 diabetes—is usually associated with central (visceral) obesity, hyperinsulinemia, and insulin resistance as well as hypertension and dyslipidemia. This constellation of findings, often termed “the metabolic syndrome” (Figure 1), leads to premature cardiovascular, cerebrovascular, and renal disease. Role of Microalbuminuria Treatment and prevention of the metabolic syndrome, especially hypertension, are paramount to improving outcomes in patients with diabetes. “Unfortunately, treatment often comes too late because the metabolic syndrome has already translated into organ damage when interventions are implemented,” says Hermann G. Haller, MD. “Ideally, clinicians should strive to prevent this organ damage using markers for diagnostics as well as treatment. One of the integral markers is microalbuminuria.” Microalbuminuria occurs when there is excess leakage of albumin from glomerular capillaries into urine. Microalbuminuria is a marker of generalized vascular disease as well as incipient diabetic nephropathy. While microalbuminuria is not indicative of overt cardiovascular disease (CVD) or kidney failure, it is an early marker and indicates the first pathological changes in the organs. ROADMAP Study The ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention) study was initiated to determine whether olmesartan, an angiotensin-receptor blocker (ARB), could prevent the development of microalbuminuria in subjects with type 2 diabetes (plus one additional cardiovascular risk factor) who had no...