Diabetic nephropathy: new appraoches, new therapies

In the United States and in the industrialised countries of Europe, in Japan, India and Africa, diabetes is the condition most frequently associated with endstage renal disease (ESRD). In those countries where ESRD registries are maintained, diabetic nephropathy has been shown to have a higher prevalence than hypertension and glomerulonephritis among new ESRD patients, and Mauer and Chavers (1985) have described diabetes as"...the most important cause of ESRD in the Western world." In the US and the Caribbean, diabetes is predominantly Type 2 (NIDDM) with fewer than 10 percent of patients with diabetes being insulinopenic or C-peptide negative. Twenty years ago it was a commonly expressed view that diabetic nephropathy was an infrequent complication of Type 2 diabetes. Since that time a number of prospective studies of Type 1 and Type 2 diabetes have shown the diabetic nephropathy at comparable rates in the two groups of patients. The Diabetes Control and Complications Trial (DCCT) unequivocally linked the renal, retinal, and neurological complications of diabetes to hyperglycemia and to the failure to achieve so called "tight" glycemic control. Intensive diabetes therapy delayed the onset and slowed the progression of retinography and, additionally, delayed the development of microalbuminuria (>28 ug/min) and the development of overt nephropathy (albuminuria >208 ug/min) in patients with baseline microalbuminuria (DCCT Research Group, 1993). Whatever may be the mechanism(s) through which hyperglycemia produces micro and macrovasculopathy, indolent and slowly progressive process effect these end-results. Not surprisigly, abnormal glycosylated haemoglobin (HbA) levels best predict the development of the microvascular and marcovascular complications of diabetes (Harris and Eastman, 1996).(Au)

The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention

Habitual xylitol gum-chewing may have a long-term preventive effect by reducing the caries risk for several years after the habitual chewing has ended. The goal of this report was (1) to determine if sorbitol and sorbitol/xylitol mixture provide a long-term benefit, and (2) to determine which teeth benefit most from two-year habitual gum-chewing - those erupting before, during, or after habitual gum-chewing. Children, on average 6 years old, chewing gums sweetened with xylitol, sorbitol, or xylitol/sorbitol mixture. There was a "no gum" control group. Five years after the two-year program of habitual gum-chewing ended, 288 children were re-examined. Compared with the no-gum group, sorbitol gums had no significant long-term effect (relative risk (RR), 0.65; 95 percent confidence interval [c.i]. 0.39 to 1.07; p < 0.18). Xylitol gums and, to a lesser extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5 years after habitual gum-chewing ended, xylitol gums reduced the caries risk 59 percent (RR, 0.41; 95 percent c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums reduced the caries risk 44 percent (RR, 0.56; 95 percent c.i., 0.36 to 0.89; p < 0.02). The long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02). Teeth that erupted after 1 year of gum-chewing or after the two-year habitual gum use ended had long-term caries risk reduction of 93 percent (p < 0.0054) and 88 percent (p < 0.0004), respectively. Teeth that erupted before the gum-chewing started had no significant long-term prevention (p < 0.30). We concluded that for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt.(AU)