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- May 17, 2008 |
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"Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?"Dr. Richard E. Gilbert (biography)
English - 2006-04-28 - 26 minutes
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Summary :
In this presentation Dr. Gilbert talks about anti-hypertensive therapy in the prevention and treatment of diabetic nephropathy, recent advances in understanding and remaining questions.
Are ACE inhibitors and ARBs equally good at slowing the progression of diabetic nephropathy? Studies such as IDNT and RENAAL have demonstrated renal benefits with ARBs in type 2 diabetic patients with nephropathy, but have been criticised for lack of a comparison with an ACE inhibitor. The DETAIL study did however compare the two agents, which were shown to have similar effects on change in glomerular filtration rate as the primary endpoint, also in patients with type 2 diabetes and nephropathy (1).
The IRMA2 study showed that treatment with 300mg (but not 150mg) of irbesartan significantly reduced the progression from microalbuminuria to overt diabetic nephropathy, but is the combination of an ACE inhibitor and ARB better? Dr. Gilbert discusses the CALM and CALM II studies which raise the question of whether increasing the dose of a single agent confers similar benefits to those from combination treatment with submaximal doses, in terms of blood pressure reduction as well as anti-albuminuric effects, again in the context of type 2 diabetes.
The BENEDICT trial investigated the effects of treatment with trandolapril plus verapamil or either agent alone, on the incidence of microalbuminuria in type 2 diabetic subjects with hypertension and normoalbuminuria (2). Dr. Gilbert presents the findings of the study and further discusses how to approach anti-hypertensive therapy in diabetes.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence of diabetic nephropathy and associated cardiovascular risk
- Effects of ARBs and ACE inhibitors on progression of diabetic nephropathy: current knowledge and remaining questions
- Evidence for decreased incidence of microalbuminuria with anti-hypertensive therapy in diabetic patients
- Approach to anti-hypertensive therapy in diabetes
Bibliographic references :
1. Anthony H. Barnett, M.D., Stephen C. Bain, M.D., Paul Bouter, Ph.D., Bengt Karlberg, M.D., Sten Madsbad, M.D., Jak Jervell, Ph.D., Jukka Mustonen, Ph.D., for the Diabetics Exposed to Telmisartan and Enalapril Study GroupAngiotensin-Receptor Blockade versus Converting–Enzyme Inhibition in Type 2 Diabetes and Nephropathy N Engl J Med. 2004 Nov 4;351(19):1952-61.
2. Piero Ruggenenti, M.D., Anna Fassi, M.D., Anelja Parvanova Ilieva, M.D., Simona Bruno, M.D., Ilian Petrov Iliev, M.D., Varusca Brusegan, M.D., Nadia Rubis, R.N., Giulia Gherardi, R.N., Federica Arnoldi, R.N., Maria Ganeva, Stat.Sci.D., Bogdan Ene-Iordache, Eng.D., Flavio Gaspari, Ph.D., Annalisa Perna, Stat.Sci.D., Antonio Bossi, M.D., Roberto Trevisan, M.D., Alessandro R. Dodesini, M.D., Giuseppe Remuzzi, M.D., for the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) InvestigatorsPreventing Microalbuminuria in Type 2 Diabetes N Engl J Med. 2004 Nov 4;351(19):1941-51.
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