Treatment Goals

Remember – prevention is the best medicine. Today we’ll be tackling the treatment options for diabetic nephropathy. Really though, diabetic nephropathy cannot be treated; only the symptoms can be treated. So the best solution here is to prevent the need for treatment.

The basis for the prevention of diabetic nephropathy is the treatment of the risk factors. As you may recall from a previous entry, the risk factors are hypertension (high blood pressure), hyperglycemia (high blood sugar), smoking and dyslipidemia (high cholesterol levels). These same risk factors are also significant contributors to heart disease. Let’s discuss these one by one.

1.     Blood pressure control

·      It is important to maintain blood pressure below 140/80 mmHg.

·      40% of type 1 and 70% of type 2 diabetes patients have high blood pressure.

2.     Blood Glucose control

·      The goal here is to keep a1c levels less than 7%. A1c levels are an indicator of diabetes and blood sugar levels.

·      The goal for blood sugar will vary from person to person. This should be determined in conjunction with your provider.

3.     Smoking

·      It is important to discuss a smoking cessation program with your healthcare provider.

4.     High cholesterol

·      Modified through diet – reduce cholesterol intake. Your provider may have you on a medication that lowers LDL cholesterol, a statin.

Basically diabetic nephropathy is treated with medications that lower blood pressure and protect the kidneys. Medications that might be administered:

·      ACE inhibitors – these meds can lower the amount of protein lost in the urine and make it easier for blood to flow through our vessels

·      Angiotensin – receptor blockers – these meds make it easier for blood to flow through vessels and reduce blood pressure

·      Diuretics – these meds get rid of excess sodium and water and decrease our blood volume and pressure  

·      Calcium channel blockers – these meds lower blood pressure

To summarize, here are the takeaways for prevention and treatment of diabetic nephropathy:

1.     Maintain blood pressure below 140/80 mmHg.

2.     Strict blood glucose monitoring. Set goals with your doctor.

3.     Reduce or stop smoking

4.     Change diet to decrease cholesterol

Reinhartz, L., Crowell, K., Ludolph, K., Roberts, C., Wargo, R., & Campbell, M. (2013). American Diabetes Association Revises Standards of Care. LECOM School of Pharmacy. http://lecom.edu/cdir/news.php/american-diabetes-association-revises-standards-of-care/240/0/2794/23009

Gross, J.L., Azevedo, Silveiro, Canani, Caramori, Zelmanovitz. (January 2005). Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Care, 28 (1) doi:10.2337/diacare.28.1.164