Chronic diseases developed by diabetes
Introduction
Diabetes mellitus can trigger different pathologies if it is not detected or treated in time, this can damage various organs such as the kidney, since this is one of the main organs damaged by type 2 diabetes. This disease is a risk factor for chronic renal disease and is the main cause of ERC.
Developing
Diabetes is an important modifiable risk factor for ERC development. DM2 represents the main cause of ERC and is a frequent morbidity in non -diabetic nephropathy. It has been estimated that 27.9 % of patients with DM2 in Spain present ERC and that more than 35 % have microalbuminuria, proteinuria or ERC. According to these data, in Spain there would be about 2 million people with diabetes and various degrees of renal involvement. Studies conducted in different countries have found that, in the population with DM2, the prevalence of microalbuminuria (the most early manifestation of diabetic nephropathy) and proteinuria is 27-43 % and 7-10 %, respectively. It is recommended to perform at least annually a screening of renal function, by determining the FG and albuminuria, in all patients with DM2. Diabetic nephropathy is an important morbidity and mortality marker in the patient with diabetes. Microalbuminuria and decreased FG below 60 ml/min/1.73 m² are considered a main cardiovascular risk factor in the Joint National Committee report. It was observed that as albuminuria increased and the estimated FG decreased, the patient with DM2 presented more cardiovascular events, so that for an albumin/creatinine ratio> 300 mg/g and an estimated FG of 60 ml/min/1.73m², the risk of suffering a cardiovascular or renal event was 3.2 and 22 times higher, than in patients with both normal values. The presence of proteinuria in the patient with diabetes, even with normal FG figures, is a powerful indicator of renal disease and mortality progression. Macroalbuminuria is better predictor of the renal deterioration rate than the basal FG level. The renal deterioration rate is also higher in diabetic elders.
Hypertension is a factor involved in the progression of ERC together with proteinuria and bad control of hydrocarbon metabolism. In patients with ERC, the objective of antihypertensive treatment is triple: reduce blood pressure, reduce the risk of cardiovascular complications and delay the progression of ERC. One of the factors that accelerate renal functional deterioration is dyslipidemia, regardless of its promoter effect of arteriosclerosis. ERC subjects should be considered high or very high cardiovascular risk, without requiring risk scales. The presence of ERC with FG < 60 ml/min/1,73 m² clasifica al sujeto como equivalente coronario y establece un objetivo de c-LDL < 70 mg/dl o una reducción del 50 % si el objetivo previo no es alcanzable. La ERC es un factor de riesgo para el desarrollo de hipoglucemia. Los pacientes con diabetes y ERC, en comparación con los que no presentan ERC, tienen un riesgo doble de sufrir una hipoglucemia grave. La insulina tiene un aclaramiento renal, por lo que las necesidades de esta suelen reducirse en presencia de insuficiencia renal (FG < 60 ml/min/1,73 m²) además, la degradación de la insulina en los tejidos periféricos disminuye en pacientes con ERC. Los pacientes con uremia frecuentemente presentan hiporexia, desnutrición y reducción de los depósitos de glucógeno hepático, y la gluconeogénesis renal disminuye a medida que se reduce la masa renal. El riesgo de hipoglucemia grave puede ser particularmente alto en pacientes en diálisis y en aquellos que sufren neuropatía autonómica, en los que los síntomas de alarma adrenérgicos suelen estar ausentes.
Type of study: • Variable analytics: age, sex, type 2 diabetes mellitus, chronic renal disease, hypertension, dyslipidemias. Constant: • Time, place and population incidence and frequency in which there is: • The prevalence of diabetes in Spain has been estimated close to 14 % of the adult population. • The Epidemiology study of chronic renal failure in Spain, estimated that approximately 10% of the adult population would suffer from some degree of ERC. • 27.9 % of patients with DM2 in Spain present ERC. • More than 35 % have microalbuminuria, proteinuria or ERC. • In Spain there would be about 2 million people with diabetes and various degrees of renal affectation. • The prevalence of proteinuria is significantly increased from the 15 years of diabetes diagnosis. EVALUATION: • Diagnostic tests for chronic kidney disease: Blood creatinine test Glomerular filtration rate Urine albumin • Diagnostic tests for type 2 diabetes mellitus
conclusion
In this study we analyze the various causes of chronic kidney disease when they have type 2 diabetes mellitus. There are currently various treatments to be able to treat the two diseases without affecting the other. Analyzing the study is recommendedtwo. Metformin remains the frontline drug in the treatment of DM2 in all patients with an estimated FG of more than 45 ml/min/1.73 m². In patients with peritoneal dialysis, the administration of intraperitoneal insulin can be preferable to its subcutaneous administration, as it achieves a better glycemic control, although the lipid profile worsens (descent of high density lipoprotein cholesterol, increased triglycerides)
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