Therapy of Diabetic Renal Disease

Abstract

Diabetes mellitus, a systemic disorder in which persistent hyperglycemia results from insulin deficiency, malsynthesis, or cellular unresponsiveness, may be complicated by several renal syndromes (Table 1). During the past decade in which uremic diabetics have been treated by peritoneal and hemodialysis, and kidney transplantation, the full extent of the burden of diabetic nephropathy has become evident (1). In 1982, one in four patients begun on uremia therapy in the United States was diabetic. Approximately $ 1.5 billion is spent annually by Medicare for renal failure, of which uremic diabetics who have excess morbidity and mortality as compared to nondiabetics, will consume more than their numerical share of time, hospital space, and funds. There is however reason for optimism in weighing the plight of the uremic diabetic. Evidence accumulated over the past five years indicates that controlling hypertension and strictly regulating hyperglycemia will retard the rate of progression of diabetic microvasculopathy including glomerulopathy. It follows that a central theme in constructing a strategy for long term diabetic management must be a striving for euglycemia throughout the day.