The treatment of diabetes complications places an increasing burden on healthcare systems around the globe. This is why preventive measures are extremely important, because they are not just preventing complications and thereby maintaining the patient’s quality of life for many years, they are also significantly more cost-effective than the treatment. Among other things, consistently high blood sugar damages the cardiovascular system, the peripheral nerves and the eyes.
Prevention is also important for the kidneys: “High blood sugar levels cause hyperfiltration of the kidneys, that is to say it filters larger quantities of blood. At first, this seemingly improves kidney function, but hyperfiltration also causes secondary damage. This results in so-called diabetic glomerulosclerosis, a morphological change in renal corpuscles, which filter urine, so that they allow proteins to pass through,” explains Professor Jürgen Steinhoff of the University Hospital Schleswig-Holstein in Lübeck, Germany.
Steinhoff is going to give a lecture on current studies on diabetic nephropathy at the MEDICA EDUCATION CONFERENCE. In the worst-case scenario, kidney damage can lead to kidney failure and the need for dialysis of the patient. A nephropathy shows early in urinary protein excretion, albuminuria, and is still reversible in the initial stages of the disease before protein excretion becomes excessive: “The most important part of prevention is the reduction of protein excretion by stabilizing blood glucose levels. Even more important are normal blood pressure levels, because high blood pressure is especially damaging to the kidneys. This is why patients should also not smoke, because smoking and high blood pressure are closely connected.“ Even though renal failure and thus a need for dialysis cannot be prevented in all patients, good prevention could delay it for many years by maintaining the condition of the kidneys, adds Steinhoff.
From a diagnostic point of view, early detection of diabetic nephropathy is quite possible today, as Steinhoff describes: “You give an albumin urine test, the so-called microalbumin. This marker is an indication for early medical treatment against hyperfiltration of the kidneys. The drugs, ACE inhibitors or sartans engage with the so-called RAAS system.“ RAAS stands for renin-angiotensin-aldosterone system, which regulates blood pressure and the body’s salt and water balance.
However, in Steinhoff‘s opinion, it is very important that screening in the future can also take place nationwide in a general practitioner’s office: “Although general practitioners are increasingly aware to pay attention to this, health insurance companies do not always pay for these tests as they should be for diabetics.“ This is why the examinations remain sketchy. “Patients, who develop diabetic nephropathy, need early detection before the condition has progressed too far. At the latest, after detection of microalbuminuria, the mentioned drugs need to be consequently used to slow down the progression of damages,“ Steinhoff continues.
For medical practices specializing in diabetes, a protein excretion test is not a cost issue. However, patients are often only referred to them, when late effects of diabetes are developing. In the case of nephropathy, on average this takes place after five years, during which time you could still do a lot for the kidneys in terms of prevention.
During his presentation at the MEDICA EDUCATION CONFERENCE, Professor Steinhoff will address the current situation in studies on diabetic nephropathy: “Current studies show the effectiveness of RAAS inhibitors, they show how important maintaining normal blood pressure is for patients with excess protein excretion and how stabilizing blood glucose levels can delay nephropathy for as long as possible. In addition, I will point out the diagnostic possibilities to detect microalbuminuria.“
MEDICA EDUCATION CONFERENCE: Topic "Diabetes"
• Thursday, 13.11., 9.00-10.30 a.m., "Endocrinology: Diabetes complications", CCD South, Room 18 - with presentation from Prof. Steinhoff
• Thursday, 13.11., 13.30-15.00 p.m., "Endocrinology: Diabetes technology", CCD South, Room 6
• Thursday, 13.11., 15.30-17.00 p.m., "Geriatrics: Diebetes mellitus in old age - specific challenges", CCD South, Room 6
• Saturday, 15.11., 09.00-10.30 a.m., "Diabetes: Diabetes and technology", CCD South, Room 111
• Saturday, 15.11., 11.00-12.00 a.m., "Diabetes: New technologies", CCD South, Room 111