Complications of Type 1 Diabetes

Diabetic kidney disease is a severe complication of type 1 diabetes and occurs in more than 30% of the patients after 10-20 years.  Its first detectable manifestations are leakage of albumin into urine and increased filtration of urine in the glomeruli of the kidneys.  Subsequently, there is usually a gradual progression of the disorder with increasing amounts of protein being excreted in urine and diminishing rate of filtration of urine due to structural changes in the kidneys.  Diabetic nephropathy is often accompanied by elevated blood pressure.  The current standard therapy for renal dysfunction in diabetes, besides strict glycemic control, is angiotensin converting enzyme inhibitors or angiotensin II receptor blockers.  However, while effective in lowering blood pressure, neither medication has been shown to slow the progression of disease or influence renal structural abnormalities.  Eventually, when glomerular filtration is severely reduced, the patient reaches end stage renal disease and dialysis treatment or renal transplantation become necessary.  A high mortality rate is associated with proteinuria and end stage renal disease.