SOCIOECONOMIC IMPACT OF DIABETIC NEPHROPATHY - CAN WE IMPROVE THE OUTCOME

Background The prevalence of non-insulin-dependent diabetes mellitus-a ssociated nephropathy is increasing worldwide. Obviously, a greater co mmitment of time is required from health providers to care for such pa tients. Moreover, when these patients develop end-stage renal disease, healthcare costs increase geometrically when Viewed in the total cont ext of lost wages and increased health-care expenditures. Intervention s 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 Angiote nsin converting enzyme (ACE) inhibitors should be part of the blood pr essure-lowering therapy in all such patients, Recent data support the concept that addition of an ACE inhibitor to other blood pressure-lowe ring regimens delays the time to dialysis. Moreover, non-dihydropyridi ne calcium channel blockers should also be added for blood pressure co ntrol in these patients. Studies Recent evidence from long-term studie s in patients with nephropathy from non-insulin-dependent diabetes sug gest that this subclass of calcium blockers is similar in efficacy to ACE inhibitors. Conclusions The use of these strategies to reduce arte rial systolic/diastolic pressure to <130/80 mmHg will provide long-ter m benefit both to the patient and to society.