The DCCT (Diabetes Control and Complications Trial) relating to the impact of glucose control on the progression of diabetic kidney disease.

  1. Discuss the study design and results from the DCCT (Diabetes Control and Complications Trial) relating to the impact of glucose control on the progression of diabetic kidney disease. (The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993;329:977-986.)
  2. What clinical trial endpoints have been shown to improve when ACE inhibitors and/or ARBS are used in preventing the progression of kidney disease in patients with diabetes? Which patients with diabetes benefit the most? At what point is it recommended that an ACE inhibitor or ARB be initiated in a patient with diabetes?
  3. Discuss the results of the ONTARGET trial (Renal outcomes with telmisartan, ramipril or both in people at high vascular risk: a multicentre, randomized, double-blind, controlled trial. Lancet 2008;372:547-53.) with regard to renal outcomes seen when an ACE inhibitor was combined with an ARB for renal protection. What do the ADA and JNC 8 recommend in regard to the combination?

4) What are the benefits of spironolactone for the obvious indications of HTN and CHF- what are the more nontradtional usage of this steroidal agent and if patients develop side effects- do we have competitor medications that will accomplish the desired therapeutic goals?

5) What is in current lay literature and newspapers regarding Kidney stones?