Diabetes

Rational:

Diabetes is a complex group of diseases marked by high blood glucose (blood sugar) due to the body’s inability to make or use insulin. Left unmanaged, diabetes can lead to serious micro- and macro-vascular complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death [1]. Chronic kidney disease attributed to diabetes, occurs in 20–40% of patients with diabetes; in Israel, it is the leading cause of end-stage renal disease. The condition is diagnosed by the presence of elevated urinary albumin excretion (albuminuria), low estimated glomerular filtration rate (eGFR), or other manifestations of kidney damage. It is therefore recommended to document urinary protein levels and GFR for individuals with diabetes at least once a year. Upon diagnosis, it is recommended to optimize glucose and blood pressure control, in order to slow the progression of the kidney disease. Hypertension is a strong risk factor for the development and progression of diabetic kidney disease. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARBs) are the preferred first-line agents for blood pressure treatment among patients with diabetes, hypertension, and kidney disease, as they were shown to prevent the progression of kidney disease and prevent major cardiovascular events [2].