{"id":888,"date":"2020-03-12T04:13:31","date_gmt":"2020-03-12T04:13:31","guid":{"rendered":"https:\/\/staging.advancedrenaleducation.com\/wparep\/?post_type=article&p=888"},"modified":"2025-05-09T17:32:22","modified_gmt":"2025-05-09T22:32:22","slug":"diabetes-and-diabetic-nephropathy","status":"publish","type":"article","link":"https:\/\/staging.advancedrenaleducation.com\/wparep\/article\/diabetes-and-diabetic-nephropathy\/","title":{"rendered":"Diabetes and Diabetic Kidney Disease"},"content":{"rendered":"

Diabetes Mellitus<\/h3>\n

Etiology and Classification<\/h4>\n

Diabetes<\/span> mellitus (DM), often referred to as diabetes, is a group of metabolic diseases characterized by high glucose levels, or hyperglycemia that result from defects in insulin secretion, action, or both (<\/span><\/span>1\u20133)<\/span><\/span><\/span>. DM is the most common disorder of the endocrine system and has been classified into Type 1, Type 2 and gestational diabetes. Type I DM, previously known as juvenile or insulin-dependent diabetes, accounts for 5%-10% of the total diabetic population (<\/span><\/span>1\u20133)<\/span><\/span><\/span>. In Type I DM, an autoimmune reaction destroys pancreatic beta cells which results in severe insulin deficiency or complete non-production of insulin (<\/span><\/span>1\u20133)<\/span><\/span><\/span>. Individuals with Type I DM typically require exogenous insulin replacement therapy and\/or transplantation of pancreas or pancreatic islet cells in order to survive. Type I DM occurs most commonly in children and young adults, although disease onset can occur at any age. Type II DM, previously known as adult-onset or non-insulin dependent diabetes, accounts for 90%-95% of the diabetic population (<\/span><\/span>1\u20133)<\/span><\/span><\/span>. Type II DM is associated with insulin resistance and increased insulin levels. Over time, a gradual reduction in insulin secretion by the pancreas is often seen, leading to decreasing hyperinsulinemia in later stages (<\/span><\/span>1\u20133)<\/span><\/span><\/span>. Management of Type II DM focuses on lifestyle changes in combination with pharmacologic interventions. Increased risk for Type II DM is associated with older age, obesity, family history, physical inactivity, ethnicity, and a host of other factors (<\/span><\/span>1\u20133)<\/span><\/span><\/span>. Gestational diabetes is thought to be caused by insulin-interfering hormones produced during pregnancy. Although gestational diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 40 to 60 percent chance of developing Type II DM within 5 to 10 years (<\/span><\/span>1\u20133)<\/span><\/span><\/span>.<\/span><\/span>\u00a0<\/span><\/p>\n

Prevalence:<\/h4>\n

In 2019, it was estimated that 463 million people worldwide had diabetes and prevalence is projected to increase to 700 million by 2045 (<\/span><\/span>4)<\/span><\/span><\/span>. Similarly, the prevalence of diabetes in the United States has been on the rise for the past three decades. Current statistics from the 2018 Centers for Disease Control and Prevention (CDC) National Diabetes Facts Sheet estimate 34.1 million adults aged 18 years or older or 13.0% of all US adults had diabetes, with over 7 million (2.8 % of all US adults) of those cases being undiagnosed.\u00a0 In addition, an estimated 88 million people had prediabetes in 2018 based on their fasting glucose or HbA1c level (<\/span><\/span>2)<\/span><\/span><\/span>. During 1999\u20132016, the age-adjusted prevalence of total diabetes significantly increased among adults aged 18 years or older (Figure 1). The estimates of new cases of diabetes in the year 2018 among US adults aged 18 years or older were 1.5 million or 6.9 per 1,000 persons. Compared to adults aged 18 to 44 years, incidence rates of diagnosed diabetes were higher among adults aged 45 to 64 years and those aged 65 years and older.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

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Figure\u00a0<\/span><\/span>1<\/span><\/span><\/span>\u00a0Trends in Incidence and Prevalence of Diagnosed Diabetes Among Adults Aged 18 or Older, United States, 1980\u20132015\u00a0<\/span><\/span>5<\/span><\/span><\/span>. Note: Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes.<\/span><\/span>\u00a0<\/span><\/p>\n

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Figure\u00a0<\/span><\/span>2<\/span><\/span><\/span>. Trends in age-adjusted prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 1999\u20132016 (<\/span><\/span>2)<\/span><\/span><\/span>.<\/span><\/span>\u00a0<\/span><\/p>\n

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The worldwide prevalence of diabetes in women in 2019 is estimated to be 9.0%, and 9.6% in men (Figure 3).<\/span><\/span>\u00a0<\/span><\/p>\n

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Figure\u00a0<\/span><\/span>3<\/span><\/span><\/span> Worldwide diabetes prevalence by age and sex in 2019 (<\/span><\/span>4)<\/span><\/span><\/span>.<\/span><\/span>\u00a0<\/span><\/p>\n

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This growing prevalence of diabetes can be attributed to the longer life expectancy of the general population, improved detection techniques and diagnostic criteria (<\/span>6)<\/span>, as well as a rise in both obesity and metabolic syndrome (<\/span>7,8)<\/span>. As of 2016, more than 4,100 diabetes self-management education and support (DSMES) programs (with an estimated 1.1 million participants) were offered nationwide (<\/span>2,5)<\/span>.<\/span>\u00a0<\/span><\/p>\n

Childhood Type II DM has also increased over the past three decades, and seems to parallel the rising rates of childhood obesity (<\/span>9,10)<\/span>. Of the estimated 34.2 million people diagnosed with diabetes, 210,000\u00a0 are children and adolescents under 20 years, accounting for approximately 0.25 % of that population (<\/span>2,5)<\/span>. Data from the SEARCH for Diabetes in Youth Study indicated that during 2014\u20132015, the estimated annual incidence of diagnosed diabetes in youth was estimated approximately 18,200 with type 1 diabetes, 5800 with type 2 diabetes (<\/span>2)<\/span>. According to the National Health and Nutrition Examination Surveys (NHANES) the prevalence of obesity among U.S> youth ages 2-19 years was 18.5 % in 2015-2016. From 1999\u20132000 through 2015\u20132016, a significantly increasing trend in obesity was observed in both adults and youth. The observed change in prevalence between 2013\u20132014 and 2015\u20132016, however, was not significant among either adults or youth. Overall, the prevalence of obesity among adolescents (12\u201319 years) (20.6%) and school-aged children (6\u201311 years) (18.4%) was higher than among preschool-aged children (2\u20135 years) (13.9%) (<\/span>11)<\/span>. Studies have shown a strong correlation between obesity and diabetes; specifically, 25% of obese children have an impaired glucose tolerance and 1% to 2% of obese children develop Type II DM. Thus, it\u2019s not surprising that Type II DM accounts for nearly 45% of new cases of diabetes in the pediatric population, and that 2 million US adolescents under the age of 20 currently have impaired glucose tolerance (<\/span>5)<\/span>.<\/span>\u00a0<\/span><\/p>\n

In 2015, diabetes was the seventh leading cause of death in the US (<\/span>5)<\/span>. The overall risk of death among diabetics is nearly twice that of people without diabetes (<\/span>5)<\/span>. Diabetic complications affect both the macrovasculature (such as coronary artery disease and peripheral vascular disease) and the microvasculature (such as retinopathy, nephropathy, and neuropathy) (<\/span>3)<\/span>; it also significantly impacts mortality rates. In 2016, a total of 7.8 million hospital discharges were reported with diabetes as any listed diagnosis among US adults aged 18 years or older (339.0 per 1,000 adults with diabetes). These discharges included 1.7 million in major cardiovascular diseases (75.3 per 1,000 adults with diabetes) and 168,000 for diabetic ketoacidosis (<\/span>5)<\/span>. In addition, diabetes is responsible for 130,000 amputations (<\/span>5)<\/span>, 11.7 % new cases of blindness (<\/span>2)<\/span>, and over 500,000 hospitalizations each year.\u00a0<\/span>\u00a0<\/span><\/p>\n

These complications make diabetes an expensive disease, with an estimated annual cost of 327 billion dollars in 2017 (including 237 billion direct and 90 billion indirect medical costs). It is further estimated that 1 out of every 10 health care dollars is spent due to diabetes or its complications. In 2017, diabetes was the seventh leading cause of death in the United States. This finding is based on 83,564 death certificates in which diabetes was listed as the underlying cause of death (crude rate, 25.7 per 100,000 persons) (<\/span>2)<\/span>.<\/span>\u00a0<\/span><\/p>\n

Screening and Diagnosis:<\/span>\u00a0<\/span><\/p>\n

The 2018 American Diabetes Association (ADA) recommended that testing for diabetes in all adults who are overweight or obese (BMI \u226525 kg\/m<\/span>2<\/span>\u00a0or \u226523 kg\/m<\/span>2<\/span>) and have one or more additional risk factors such as (<\/span>12)<\/span>:<\/span>\u00a0<\/span><\/p>\n