《2010CARI2型糖尿病患者中慢性肾脏病的预防和管理》内容预览

The HbA1c target may need to be individualized tak-ing in to account history of hypoglycaemia and co-morbidities. (refer to NHMRC Evidence Based Guide-line for Blood Glucose Control in Type 2 Diabetes at http://www.nhmrc.gov.au).
Systolic blood pressure (SBP) appears to be the best indicator of the risk of CKD in type 2 diabetes. However, an optimum and safest lower limit of SBP has not been clearly defined.
In people with type 2 diabetes antihypertensive therapy with ARB or ACEi decreases the rate of progression of albuminuria, promotes regression to normoalbuminuria, and may reduce the risk of decline in renal function.
Due to potential renoprotective effects, the use of ACEi or ARB should be considered for the small sub- group of people with normal BP who have type 2 diabetes and microalbuminuria.
 The extent to which interventions with lipid lowering therapy reduces the development of CKD in people with type 2 diabetes is unclear. As there is limited evidence relating to effects of lipid treatment on the progression of CKD in people with type 2 diabetes, blood lipid profiles should be managed in accordance with guidelines for pre-vention and management of cardiovascular disease (CVD).
 Lifestyle modification (diet and physical activity) is an integral component of diabetes care (refer to the NHMRC Evidence Based Guidelines for Blood Glucose Control in Type 2 Diabetes), however, there are insufficient studies of suitable quality to enable dietary recommendations to be made with respect to prevention and/or management of CKD in people with type 2 diabetes

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