Preventing Microalbuminuria in Type 2 Diabetes

In a multicenter, double-blind, placebo-controlled, randomized study, subjects with type 2 diabetes mellitus and hypertension but normal urinary albumin levels were treated with an angiotensin-converting–enzyme (ACE) inhibitor (trandolapril) and a non-dihydropyridine calcium-channel blocker (verapamil) alone or in combination to investigate whether treatment could forestall the development of microalbuminuria, which heralds diabetic nephropathy. The use of trandolapril alone or with verapamil appeared to be effective, whereas verapamil alone was no better than placebo. ACE inhibition may prevent or retard the development of microalbuminuria in patients with type 2 diabetes mellitus. Type 2 diabetes mellitus is a public health concern, and projections of its future effect are alarming. According to the World Health Organization, diabetes affects more than 170 million people worldwide, and this number will rise to 370 million by 2030. 1 About one third of those affected will eventually have progressive deterioration of renal function. 2 The first clinical sign of renal dysfunction in patients with diabetes is generally microalbuminuria (a sign of endothelial dysfunction that is not necessarily confined to the kidney), 4 which develops in 2 to 5 percent of patients per year. 5 , 6 In type 2 diabetes, unlike type . . .