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Published by: Datamonitor
Published: Nov. 5, 2008 - 88 Pages
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE
- About the cardiovascular analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into available therapies in advanced heart failure
- Contributing experts
- CHAPTER 2 BACKGROUND
- Diabetes mellitus
- Definition
- Segmentation of diabetes
- Type 1 diabetes
- Type 1.5 diabetes
- Type 2 diabetes
- Mechanisms of development of diabetes
- Genetic or acquired causes
- Diabetic complications
- Microvascular complications
- Retinopathy
- Neuropathy
- Nephropathy
- Macrovascular complications
- Effect of macrovascular complications on type 2 diabetes treatment
- End-stage disease considerations
- Co-morbidities
- Obesity
- Effect of obesity on type 2 diabetes treatment
- Hypertension
- Dyslipidemia
- CHAPTER 3 DIABETIC RENAL DISEASE - DEFINITIONS AND OVERVIEW
- Diabetic renal disease and diabetic nephropathy
- Etiology of diabetic nephropathy
- Etiological factors influencing the development of diabetic renal disease
- Pathogenesis and natural history of renal nephropathy
- Microalbuminuria
- Pathophysiological role of hyperglycemia
- Pathophysiological role of hypertension
- Macroalbuminuria and end stage renal disease
- Chronic kidney disease and cardiovascular risk
- Diagnosis
- CHAPTER 4 TREATMENT STRATEGIES
- Pharmacotherapy
- Glycemic control
- Managing hypertension
- Benefits of ACE inhibition
- Data supporting the renoprotective benefits of ACE inhibitors.
- Benefits of angiotensin II receptor blockade
- Renin inhibitors
- Diuretics
- Calcium channel blockers
- Diet and protein restriction
- Renal replacement
- Dialysis
- Hemodialysis
- Peritoneal dialysis
- Renal transplantation
- Cultural issue
- CHAPTER 5 COMMERCIAL OPPORTUNITIES
- Battle of the antihypertensives
- Rationale for the renin-angiotensin combinations
- Development of new agents
- APPENDIX
- Report methodology
- Bibliography
- About Datamonitor
- About Datamonitor Healthcare
- About the cardiovascular analysis team
- Disclaimer
- List of Tables
- Table 1: Framingham Heart Study data on percentage lipid levels in men and women with and without diabetes
- Table 2: Stages of diabetic nephropathy: cut-off values of urine albumin for diagnosis and main clinical characteristics
- Table 3: Stages of chronic kidney disease
- Table 4: Cardiovascular risk according to stages of chronic kidney disease
- Table 5: Pharmacokinetic profiles of commercially available angiotensin II receptor blockers (ARBs)
- List of Figures
- Figure 1: Proportion of type 2 diabetics with complications in the seven major markets, 2007
- Figure 2: Proportion of type 2 diabetics with complications that suffer from microvascular and/or macrovascular complications in the seven major markets, 2007
- Figure 3: Proportion of type 2 diabetics with retinopathy in the seven major markets, 2007
- Figure 4: Average time required for the development of diabetic retinopathy in the seven major markets, 2007
- Figure 5: Proportion of type 2 diabetics with neuropathy in the seven major markets, 2007
- Figure 6: Average time required for the development of diabetic neuropathy in the seven major markets, 2007
- Figure 7: Proportion of type 2 diabetics with different stages of nephropathy in the seven major markets, 2007
- Figure 8: Average time from the diagnosis of diabetes required for the development of different stages of diabetic nephropathy in the seven major markets, 2007
- Figure 9: Proportion of type 2 diabetics with macrovascular complications in the seven major markets, 2007
- Figure 10: Average time for the development of macrovascular complications in the seven major markets, 2007
- Figure 11: Proportion of type 2 diabetics with serious complications (e.g. end-stage renal disease, acute myocardial infarction, amputation), 2007
- Figure 12: Treatment algorithm for type 2 diabetes, recommended by the 2006 ADA/EASD clinical practice guidelines
- Figure 13: Mechanism of action of ACE inhibitors
AbstractIntroduction
Prevalence of diabetic renal disease is on the rise. Current treatment focuses on the management of hypertension and glycemic control, but is unable to address the deterioration of renal function. An unmet need exists for therapies fully reversing disease progression. Early diagnosis can help to prevent the disease progression but lack of early diagnostic markers makes this option rather remote.
Scope
- What are the current definitions, pathophysiological stages and the natural history of progression of diabetic renal disease?
- What are the currently available diagnostic methods, the issues and the unmet needs in diagnosis and early detection of diabetic renal disease?
- What are the available treatment approaches in the early stages of diabetic renal disease, the unmet needs and the future trends?
- What are the treatment options in advanced stages of diabetic renal disease and the changing role of renal dialysis and kidney transplantation?
Highlights
Diabetic nephropathy, which is one of the most serious complications of diabetes, develops in approximately 50% of patients with type 1 diabetes mellitus who have had diabetes for 20 years. Although it is less prevalent in type 2 diabetes, clinically significant renal disease still develops in 1520% of type 2 diabetes individuals.
Most diabetic renal disease patients are suffering from type 2 diabetes, and are therefore diagnosed late once the disease has already reached its advanced, irreversible stages. This highlights one of the major issues in diabetic renal disease: the need for early diagnosis and good diagnostic markers and risk scores.
The only available treatment in advanced stages of diabetic renal disease is renal replacement therapy. Dialysis comes at a high cost and significantly reduces the patient's quality of life. Hence, it is clear that the main focus of clinicians is on the prevention of disease progression through stringent glycemic and blood pressure control.
Reasons to Purchase
- Understand current definitions, diagnostic methods and treatment approaches in diabetic renal disease
- Current challenges and future opportunities in diabetic renal disease management
- Differences, advantages and disadvantages of pharmacological and non-pharmacological disease management
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