Evidence-based Treatment for a Patient with Type 2 Diabetes and Microalbuminuria_Chinese Journal of Evidence-Based Medicine

Authors：

ZUO Ying ,  LI Shuangqing

Goldencard ward, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Shuangqing, Email: lanjingling7676@sina.com

Keywords：

Diabetic nephropathy; Microalbuminuria; Evidence-based treatment

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Objective 　To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria.
Methods　According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly.
Results 　Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up.
Conclusion 　Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.

Citation： ZUO Ying,LI Shuangqing. Evidence-based Treatment for a Patient with Type 2 Diabetes and Microalbuminuria. Chinese Journal of Evidence-Based Medicine, 2006, 06(7): 533-536. doi: Copy

1.	Marshall SM. Recent advances in diabetic nephropathy. Postgrad Med J, 2004; 80(949): 624-633.
2.	Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005; 28(1): 164-176.
3.	American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2006; 29(Suppl 1): 4-42.
4.	Dinneen SF, Griffin S. An intensive intervention reduced cardiovascular and microvascular events in type 2 diabetes and microalbuminuria. ACP Journal Club,2003; 139(2):29.
5.	UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). Lancet, 1998; 352(9131): 837-853.
6.	Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-Term Results of the Kumamoto Study on Optimal Diabetes Control in Type 2 Diabetic Patients. Diabetes Care, 2000; 23(Suppl 2): B21-29.
7.	Pistrosch F, Herbrig K, Kindel B, et al. Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes, 2005; 54(7): 2206-2211.
8.	Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: The Cochrane Library, 2006,Issue 2.
9.	Lovell HG. Angiotensin converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: The Cochrane Library,2005, Issue 3.
10.	Ruggenenti P, Fassi A, Ilieva AP, et al; Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing Microalbuminuria in Type 2 Diabetes. N Engl J Med, 2004; 351(19): 1941-1951.
11.	Rabbat CG. Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure. ACP Journal Club,2002; 136(3): 82-84.
12.	Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure. ACP Journal Club,2002; 136(3):82-84.
13.	Schjoedt KJ, Jacobsen P, Rossing K, et al. Dual blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy: the role of aldosterone. Hormone and Metablic Research, 2005; 37(Suppl 1): 4-8.
14.	UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 1998; 317(7 160): 703-713.
15.	Ansquer JC, Foucher C, Rattier S, et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am J Kidney Dis, 2005; 45(3): 485-493.
16.	Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profile in patient with type 2 diabetes: a randomized crossover trial. Diabetes Care, 2002; 25(4): 645-651.
17.	Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab, 2000; 26(Suppl 4): 54-63.

1. Marshall SM. Recent advances in diabetic nephropathy. Postgrad Med J, 2004; 80(949): 624-633.
2. Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005; 28(1): 164-176.
3. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2006; 29(Suppl 1): 4-42.
4. Dinneen SF, Griffin S. An intensive intervention reduced cardiovascular and microvascular events in type 2 diabetes and microalbuminuria. ACP Journal Club,2003; 139(2):29.
5. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33). Lancet, 1998; 352(9131): 837-853.
6. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-Term Results of the Kumamoto Study on Optimal Diabetes Control in Type 2 Diabetic Patients. Diabetes Care, 2000; 23(Suppl 2): B21-29.
7. Pistrosch F, Herbrig K, Kindel B, et al. Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes, 2005; 54(7): 2206-2211.
8. Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: The Cochrane Library, 2006,Issue 2.
9. Lovell HG. Angiotensin converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: The Cochrane Library,2005, Issue 3.
10. Ruggenenti P, Fassi A, Ilieva AP, et al; Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing Microalbuminuria in Type 2 Diabetes. N Engl J Med, 2004; 351(19): 1941-1951.
11. Rabbat CG. Losartan was renoprotective in diabetic nephropathy independent of its effect on blood pressure. ACP Journal Club,2002; 136(3): 82-84.
12. Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure. ACP Journal Club,2002; 136(3):82-84.
13. Schjoedt KJ, Jacobsen P, Rossing K, et al. Dual blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy: the role of aldosterone. Hormone and Metablic Research, 2005; 37(Suppl 1): 4-8.
14. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 1998; 317(7 160): 703-713.
15. Ansquer JC, Foucher C, Rattier S, et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am J Kidney Dis, 2005; 45(3): 485-493.
16. Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profile in patient with type 2 diabetes: a randomized crossover trial. Diabetes Care, 2002; 25(4): 645-651.
17. Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab, 2000; 26(Suppl 4): 54-63.

Chinese Journal of Evidence-Based Medicine

Evidence-based Treatment for a Patient with Type 2 Diabetes and Microalbuminuria

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