Socioeconomic impact of diabetic nephropathy: can we improve the outcome?

Abstract

Background: The prevalence of non-insulin-dependent diabetes mellitus-associated nephropathy is increasing worldwide. Obviously, a greater commitment of time is required from health providers to care for such patients. Moreover, when these patients develop end-stage renal disease, healthcare costs increase geometrically when viewed in the total context of lost wages and increased health-care expenditures.

Interventions: Strict control of glucose as well as a low-protein and low-salt diet are important, but ultimately, aggressive blood pressure reduction is required to markedly decrease the time to dialysis.

Treatment: Angiotensin converting enzyme (ACE) inhibitors should be part of the blood pressure-lowering therapy in all such patients. Recent data support the concept that addition of an ACE inhibitor to other blood pressure-lowering regimens delays the time to dialysis. Moreover, non-dihydropyridine calcium channel blockers should also be added for blood pressure control in these patients.

Studies: Recent evidence from long-term studies in patients with nephropathy from non-insulin-dependent diabetes suggest that this subclass of calcium blockers is similar in efficacy to ACE inhibitors.

Conclusions: The use of these strategies to reduce arterial systolic/diastolic pressure to < 130/80 mmHg will provide long-term benefit both to the patient and to society.