ACE inhibitors in diabetes

Even though there are a few reports of the protective effects of angiotensin converting enzyme inhibitors in patient with diabetes who do not have nephropathy, we know that renal protection in diabetes depends mainly on two things:
1. Good glycemic control and
2. Reduction of proteinuria.

Reference: PubMed article

The RENAAL study in 2002 also highlighted the importance of protein in the urine as a risk factor for progression towards renal failure. In the abstract from this paper it was written …"Albuminuria is the predominant renal risk marker in patients with type 2 diabetic nephropathy on conventional treatment; the higher the albuminuria, the greater the renal risk. Reduction in albuminuria is associated with a proportional effect on renal protection, the greater the reduction the greater the renal protection. The residual albuminuria on therapy (month 6) is as strong a marker of renal outcome as is baseline albuminuria. The antiproteinuric effect of losartan explains a major component of its specific renoprotective effect. In conclusion, albuminuria should be considered a risk marker for progressive loss of renal function in type 2 diabetes with nephropathy, as well as a target for therapy. Reduction of residual albuminuria to the lowest achievable level should be viewed as a goal for future renoprotective treatments."

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