Prevention of diabetic nephropathy

Prevention of diabetic nephropathy can be considered in terms of primary or secondary prevention.

With respect to type I diabetes, strategies for primary prevention appear to be mainly aimed at blood glucose control, since the DCCT study found that better glucose control reduced the incidence and progression of nephropathy in type I diabetes. For secondary prevention, once nephropathy has developed, the main aim of treatment and follow up is to control blood pressure and reduce other co-existing cardiac risk factors.

In type 2 diabetes a systematic review stated "..Intensive glucose control reduces the risk for microalbuminuria and macroalbuminuria, but evidence is lacking that intensive glycemic control reduces the risk for significant clinical renal outcomes, such as doubling of the serum creatinine level, ESRD, or death from renal disease during the years of follow-up of the trials..." (1)

The management of type II diabetic renal disease is summarised in the linked NICE guidance.

Reference:

• (1) Coca SG et al. Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus: systematic review and meta-analysis intensive glucose control in type 2 diabetes.Arch Intern Med. 2012 May 28;172(10):761-9.