Introduction of diabetic nephropathy

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The most common cause of incident ESRD and the 2nd commonest cause of prevalent ESRD in Taiwan
Prevalence
- 40% in type 1 and 2 DM
- Because type 2 DM is much more common than type 1 DM, most diabetic nephropathy patients have type 2 DM
Importance of hyperglycemia in DN
- DCCT (Diabetes Control and Complications Trial)
  - Type 1 DM
  - NEJM 1993;329:977. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus
- UKPDS (UK Prospective Diabetes Study)
  - Lancet 1998;352:837. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
  - Type 2 DM
- Intensive glycemic control (HbA1C 6.5~7%) prevents microangiopathy in newly diagnosed DM, but effects on macroangiopathy (cardiovascular diseases and atherosclerosis) are less certain