Microvascular disease: what does the UKPDS tell us about diabetic nephropathy?

Diabet Med. 2008 Aug;25 Suppl 2:25-9. doi: 10.1111/j.1464-5491.2008.02496.x.

Abstract

The UK Prospective Diabetes Study is the largest study in Type 2 diabetes with pre-specified renal outcomes. The study showed that the natural history of nephropathy in newly diagnosed Type 2 diabetic patients was similar to that described previously in those with Type 1 diabetes. Around 2% per annum progress from normo- to micro-albuminuria [urinary albumin concentration (UAC) > 50 mg/l] and a further 2% from microalbuminuria to clinical grade proteinuria (UAC > 300 mg/l). Mortality rates for those with nephropathy are high, increasing from 1.4% per annum (normoalbuminuria) to 4.6% per annum (clinical grade proteinuria), and to 19.2% per annum for those with renal impairment. More intensive blood glucose control resulted in both a 33% reduction in relative risk of development of microalbuminuria or clinical grade proteinuria at 12 years, and a significant reduction in the proportion doubling their plasma creatinine (0.91 vs. 3.52%, P = 0.0028). Tighter blood pressure control also reduced microalbuminuria and clinical grade proteinuria; but at 6 years there was no effect on plasma creatinine levels. These data underline the importance of glycaemic and blood pressure control in Type 2 diabetes in order to prevent diabetic nephropathy. Those patients unlucky enough to develop nephropathy need intensive surveillance and correction of cardiovascular risk factors.

MeSH terms

  • Albuminuria / blood
  • Albuminuria / metabolism*
  • Antihypertensive Agents / therapeutic use*
  • Blood Glucose / metabolism*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / etiology
  • Diabetic Nephropathies / prevention & control
  • Follow-Up Studies
  • Humans
  • Hypertension / drug therapy*
  • Hypoglycemic Agents / therapeutic use*
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / prevention & control
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • United Kingdom / ethnology

Substances

  • Antihypertensive Agents
  • Blood Glucose
  • Hypoglycemic Agents