Dear Diary,
Woe is me, the kidney of an obese, hypertensive, diabetic! If only I could have been in the body of a great athlete or a vegetarian. At least someone who complies with their diabetes care regimen. Today at my appointment, my doctor was explaining the great jump in Diabetic Nephropathy (DN) to me. In most western countries, DN is the number one leading cause of death in patients with end-stage renal disease (ESRD). She told me that this is due, in large part to the increase of Type II diabetes in westernized society:
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| Canadian Type II diabetes rates by year |
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| USA Type II diabetes rates by year |
Type II diabetes, especially when it is poorly managed, can lead to hyperglycemia, high blood pressure, and insulin resistance, all of which are risk factors for DN. The development of DN in people with Type II DM for less than 10 years is rare, with a much higher incidence of diagnosis between 10-20 years. This is because because diabetics are living longer lives, and DN is a progressive diease that requires time to take effect. Poor glycemic control (HbAlc) and elevated systolic blood pressure (> 135 mm Hg) interact in enhancing the risk of DN.
The epidemiology of DN in regards to race is startling: Native Americans, Mexican-Americans, and African-Americans are at a much higher risk of developing DN in ESRD than their Caucasion-American coutnerparts. This is probably due to a mix a genetic predisposition and also socio-economic-environmental factors, such as proximity to healthy food, targeted smoking ads, etc.
If only I could get my owner to stop smoking, and comply with his blood pressure medications...
American Diabetes Association. Nephropathy in Diabetes. Diabetes Care. 2004; 27 (suppl 1):S79-S83.
Epidemiology of diabetic nephropathy. Reutens AT, Atkins RC - Contrib Nephrol - ; 170 (); 1-7
graphs retrieved from : http://www.cdc.gov/diabetes/statistics/prev/national and http://partnersinprevention.ca/your-diabetic-patients
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