Diabetes - Prospects Yesterday and Today

Just a few decades ago, the diagnosis of nephropathy was a reason to be very concerned about the future. People who were found to have a high level of protein excretion in the urine (macroalbuminuria) in the 1960s or 1970s could count on needing to start dialysis within months or at most one year.

On average, they would lose 15–30% of their remaining kidney function every year. Today, not only is kidney impairment detected much earlier – at the stage of microalbuminuria – but the outlook for those affected is much brighter. Over the last 20 years, the prospects for people with nephropathy have improved more than for almost any other illness.

This has been possible because in that time we have learned so much about how nephropathy develops and progresses and, above all, how we can control it. Nowadays, there is intensive diabetes management, more and better drugs are available to lower blood pressure and the options for dialysis are markedly improved.

The pleasing consequences are shown by the results of a comparative study. In the 1960s and 1970s, two-thirds of 28 patients observed after they were found to have increased protein excretion died within five years. The most frequent cause of death was cardiovascular disease, such as a heart attack or stroke, and kidney failure, because at that time there were barely any opportunities for dialysis.

In the 1990s, all of a similar cohort of 23 patients survived the six-year observation period, without the need for dialysis. Patients and doctors today have many means at their disposal to recognize diabetic nephropathy early and to ensure good control of blood sugar levels and blood pressure – the two most important influencing factors.

If these opportunities are taken, it is possible, even when microalbuminuria is already present, to reduce the loss of kidney function to the appropriate rate for that age.

For long life expectancy, additional factors come into play, such as better options for intensive cardiological therapy – the mortality rate from heart attacks has fallen over recent decades – and the improved opportunities for managing metabolic or blood-clotting disorders.

To benefit from all this progress, you have to make use of all these possibilities over the long term. As a patient you have an important role to play – with your doctors and nurses – in the management of your diabetes. You must take a high degree of responsibility for your condition. For this, participating in a good diabetes education program is essential; not just once, but repeatedly during the lifetime of your diabetes.