Dr. de Boer often sees type 2 diabetes patients after signs of kidney trouble have surfaced. They may have very large amounts of protein in their urine (a marker of kidney disease), which is evidence of moderately impaired kidney function or difficult-to-control hypertension.
If tests reveal a problem, your doctor will recommend ways to slow the decline in kidney function and prevent kidney failure, which include the following.
- Controlling your blood sugar. The United Kingdom Prospective Diabetes Study found that intensive blood glucose management reduces the risk of kidney damage in type 2 patients.
- Controlling your blood pressure. Studies show that treating hypertension slows the progression of kidney disease. The target for people with diabetes is 130/80.
- Taking blood pressure medicines. To manage hypertension in people with diabetes, the American Diabetes Association advises doctors to prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), drugs that lower blood pressure and may have a protective effect on the kidneys of diabetics.
Zachary T. Bloomgarden, MD, an endocrinologist at Mount Sinai School of Medicine in New York City who specializes in diabetes, prescribes these drugs to most of his patients, particularly those with hypertension, cardiovascular disease, or risk factors for heart disease, such as high cholesterol. He also prescribes these drugs to patients with increased levels of albumin in urine and creatinine in the blood.