Screening for Type 2 Diabetes > Effectiveness/Harms of Early Treatment Author: Lorraine Lipscombe, MD, FRCPC; Denice S. Feig, MD, MSc, FRCPC
Editorial changes - 2009-05-01
Author information and module status
Key Points
Population at Risk
Effectiveness/Harms of Screening Tests
Effectiveness/Harms of Early Treatment
Direct Evidence that Screening Reduces Adverse Outcomes
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Recommendation
Know that treatment of type 2 diabetes patients with microalbuminuria and overt nephropathy using ACE inhibitors and angiotensin-receptor blocking agents reduces the risk of nephropathy progression.A

Evidence:

  • ACE inhibitor treatment of normotensive and hypertensive type 2 diabetes patients with microalbuminuria decreases progression of proteinuria when compared to placebo or other antihypertensive agents (93; 94; 95).
  • ACE inhibitor treatment has also been shown to preserve renal function to a greater extent than calcium-channel blocker or β-blocker treatment in type 2 diabetes patients with hypertension and overt nephropathy (urinary protein excretion >300 mg/d) (96; 97).
  • Two large randomized controlled trials have shown that angiotensin-receptor blocking treatment can reduce the progression of renal function decline in hypertensive patients with type 2 diabetes and overt nephropathy when compared to placebo (98; 99).
  • There are no studies that have directly compared ACE inhibitor to angiotensin-receptor blocking therapy.

Comments:

  • None.

FAQs
Denice S. Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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