Optimizing diabetes management

Diabetes mellitus is the fastest growing cause of end-stage renal disease and an important source of comorbidity among renal patients. A better understanding of diabetic pathophysiology has contributed to the development of effective prevention or treatment of many of its complications. The systematic application of several therapeutic recommendations based on clinical evidence can significantly reduce the rate of diabetic complications and improve the quality of life of the diabetic patient. Some of the most important recommendations are: (1) meticulous glycemic control to maintain HbA1c < or = 7.2%; (2) control of arterial blood pressure to normal levels (< 130/85 mmHg); (3) tobacco abstinence; (4) avoidance of excessive protein intake in the early stages of nephropathy; (5) aggressive nutritional monitoring and support; (6) early myocardial revascularization; (7) avoidance of unnecessary use of radiographic contrast media; and (8) appropriate initiation of dialysis with adequate delivered dose. Every effort should be made to provide effective education of the patient and health professionals. We must also develop regimens that interfere minimally with lifestyles in order to improve patient compliance with therapy.