Obese and hypertensive elderly patient, with incipient diabetic nephropathy and previous cardiovascular event, long-term treated with secretagogues

We report the case of a 75-year old patient affected by type 2 diabetes for about 20 years, treated for a prolonged period with insulin secretagogues. He is also affected by arterial hypertension, obesity and incipient diabetic nephropathy and had suffered a cardiovascular event. He was referred to us by his GP to verify his high values of glycated hemoglobin (HbA1c) and for an excessive weight increase (Diabetology)

Effects of folic acid on renal endothelial function in patients with diabetic nephropathy: results from a randomized trial

Despite encouraging pre-clinical data, this double-blind randomized clinical trial demonstrates that treatment with high-dose folic acid fails to reduce oxidant stress and albuminuria in human subjects with incipient diabetic nephropathy. Novel treatment options for this condition are urgently needed.

Determinants of Intravascular Resistance in Indian Diabetic Nephropathy Patients: A Hospital-Based Study

Aims and Objectives. Metabolic dysregulation has failed to explain clinical variability of patients with diabetic nephropathy and hence a renewed interest emerged in haemodynamic factors as determinant of progression and development of diabetic nephropathy. We therefore studied for various factors which can correlate with raised renal vascular resistance in diabetic nephropathy.Material and Methods. Renal vascular resistance was measured in patients with established and incipient diabetic nephropathy and compared with controls using noninvasive color Doppler examinations of intrarenal vasculature.Results. Renal vascular resistance correlated with age, duration of disease, GFR, serum creatinine, and stage of retinopathy. Renal vascular resistance was significantly reduced in patients on treatment with RAAS inhibitors and insulin, than those on OHA and antihypertensives other than RAAS inhibitors.Conclusion. The study implies that renal vascular resistance may help identify diabetics at high risk of developing nephropathy, and these set of patients could be candidates for RAAS inhibition and early insulin therapy even in patients without albuminuria.