(Level 4)   9. Boussageon R, et al. BMJ. 2011;343:d4169. (Level 1)   10. Hemmingsen B, et al. BMJ. 2011;343:d6898. (Level 1)   11. de Boer IH, et al. N Engl J Med.

2011;365:2366–76. (Level 4)   Is tight glycemic control recommended for suppressing the onset of CVD in patients with diabetic nephropathy? Renal dysfunction, such as microalbuminuria and proteinuria, is recognized to be an independent risk factor for the onset of CVD. Patients with CKD, including diabetic nephropathy, often develop CVD. The effect of glycemic control alone on the onset of CVD in patients with diabetic nephropathy is unclear. However, glycemic control might contribute to suppressing the onset of CVD as a core treatment in multifactorial intensive therapy for diabetic nephropathy, click here and is an important factor for achieving the remission of albuminuria. It should also be noted that tight glycemic control might increase serious hypoglycemia, and reportedly could be a risk factor for increased mortality and the development of CVD in type 2 diabetes. Therefore, glycemic control that avoids hypoglycemia is crucial, and the glycemic control target should be considered along with the risks to the individual patient. Bibliography

1. Gaede P, et al. N Engl J Med. 2003;348:383–93. (Level 2)   2. Araki S, et al. Diabetes. 2005;54:2983–7. (Level 4)   3. Araki S, et al. Diabetes. 2007;56:1727–30. Q VD Oph (Level 4)   4. Gaede P, et al. Nephrol Dial Transplant. 2004;19:2784–8. (Level 4) Dehydratase  

Which anti-diabetic medications are recommended as the first-line treatment for diabetic nephropathy? Anti-diabetic medicines include insulin and GLP-1 receptor agonist as injectable agents, and sulfonylurea, glinide, thiazolidinedione, biguanide, α-glucosidase inhibitior and dipeptidyl peptidase-4 inhibitor as oral anti-diabetic agents. There is no significant difference among anti-diabetic medications in terms of the onset and progression of diabetic nephropathy, so far. Therefore, it is necessary to select anti-diabetic Trichostatin A supplier agents to control glucose levels tightly taking into consideration the individual patient’s diabetic pathophysiology at the early stage of nephropathy. So far, there has been no study conducted to compare directly the effects of anti-diabetic medications in terms of their suppression of the onset and progression of diabetic nephropathy. At the advanced stage of overt nephropathy with a reduction in renal function, the risk of hypoglycemia might be increased. Therefore, a therapeutic agent for diabetes should be selected with consideration of the patient’s renal function to avoid the occurrence of hypoglycemia. Bibliography 1. UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837–53. (Level 2)   2. UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:854–65. (Level 4)   3. Gerstein HC, et al. N Engl J Med. 2008;358:2545–59. (Level 2)   4. Patel A, et al. N Engl J Med. 2008;358:2560–72.