Anil K Mandal
Mandal Diabetes Research Foundation University of Florida, USA
We previously reported that D-glucose is a strong predictor of renal function change in diabetes. This study is an expansion of a previous study but with longer duration. Data was compared be-tween first and last visits. 85 diabetic patients were treated with a combination of glargine or de-temir and regular or fast acting insulin for 26.3±24.6 (SD) months. Blood pressure was controlled by beta blockers, calcium channel blockers, sympathetic inhibitors or a combination and chlorthalidone in resistant cases. Angiotensin converting enzyme inhibitors and receptors blockers (ACEI/ARB) were excluded in order to reduce the risk of acute and chronic renal failure. Objectives were to determine if this paradigm of treatment prevents progression of diabetic nephropathy. Fasting (F) and 2 hours postprandial (2hPP), glucose, serum creatinine (Scr) and estimated glomerular filtration rate (eGFR); hemoglobin A1c(HbA1c); sitting systolic and dias-tolic blood pressure (SBP) were recorded for first and last visits. Mean blood pressure (MBP) and differences (d, 2hPP-F) were calculated for glucose, Scr, and eGFR. Parameters between first and last visits were compared using a paired t-test adjusted for age, gender and duration of treatment with P<0.05 considered significant. No significant differences were found between first and last visits for F and 2hPP glucose, F and 2hPP Scr, F and 2hPP eGFR, and HbA1c. D-glucose, sitting SBP and MBP were significantly lower at last compared to first visit. Combining both visits, D-glucose and HbA1c showed a direct and positive correlation with dScr. Change in post minus pretreatment values was significantly positively correlated between HbA1c and FBG, 2hPPG or D-glucose. In conclusion, the current study emphasizes the importance of control of D-glucose (2hPP-F) with insulin in preserving renal function in diabetes.
Anil K Mandal graduated from Calcutta National Medical College and obtained a Diploma of American Board of Internal Medicine. He is the author of many books and articles on research in diabetes and kidney disease. He is two-time Full bright Scholar to India and Visiting Professor to 24 countries where he has lectured on diabetes, high blood pressure and kidney disease. He be-gan the Diabetes Research Foundation for the prevention and treatment of diabetes based on his knowledge that diabetes is the most common cause of kidney failure worldwide. His convictions are in office, patients come first and in the home, children come first. He is dedicated to helping diabetic patients live a good life and not enter dialysis.
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