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Diabetic Nephropathy Dietary Recommendations

Diabetic Nephropathy - Treatment Overview

Diabetic Nephropathy - Treatment Overview

Diabetic nephropathy is treated with medicines that lower blood pressure and protect the kidneys. These medicines may slow down kidney damage and are started as soon as any amount of protein is found in the urine. The use of these medicines before nephropathy occurs may also help prevent nephropathy in people who have normal blood pressure. If you have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect the kidneys. Medicines are added one at a time as needed. If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen. It is also important to keep your blood sugar within your target range. Maintaining blood sugar levels within your target range prevents damage to the small blood vessels in the kidneys. Limiting the amount of salt in your diet can help keep your high blood pressure from getting worse. You may also want to restrict the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you. Initial treatment Medicines that are used to treat diabetic nephropathy are also used to control blood pressure. If you have a very small amount of protein in your urine, these medicines may reverse the kidney damage. Medicines used for initial treatment of diabetic nephropathy include: Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, lisinopril, and ramipril. ACE inhibitors can lower the amount of protein being lost in the urine. Also, they may reduce your risk of heart and blood vessel (cardiovascular) disease. If you also have high blo Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Diabetic nephropathy (diabetic kidney disease) is kidney damage that results from having diabetes. Having high blood glucose levels due to diabetes can damage the part of the kidneys that filters your blood. The damaged filter becomes 'leaky' and lets protein into your urine. For some people, diabetic nephropathy can progress to kidney failure. However, most people with diabetes do not develop kidney disease that progresses to kidney failure. How common is diabetic nephropathy? Diabetic nephropathy is common. One in 4 women and one in 5 men with type 2 diabetes develops diabetic nephropathy. It is even more common in type 1 diabetes. Diabetic kidney disease is the leading cause of kidney failure in Australia. Symptoms Diabetic nephropathy usually has no symptoms early on. You can't tell that there is protein in your urine – it's something that is detected with a urine test. It can take many years for the kidney damage to progress. Symptoms usually only appear when kidney damage has deteriorated significantly. Even then, the symptoms tend to be vague. If the kidney damage becomes severe, you may notice: weight loss; a poor appetite or feeling sick; swollen ankles and feet (due to retaining fluid); puffiness around the eyes; dry, itchy skin; muscle cramps; needing to pass urine more often; feeling tired; and having difficulty concentrating. What happens to the kidneys in diabetes? The main function of the kidneys is to filter waste products and excess water from the bloodstream so that they can be excreted in the form of urine. This is carried out by a system of tubes and blood vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny urine-collecting tubes. One of the major structures in the nephron is a group of blood vessels kn Continue reading >>

Dietary Adjustments For The Chronic Hypertensive Type Two Diabetic-nephropathy Patients

Dietary Adjustments For The Chronic Hypertensive Type Two Diabetic-nephropathy Patients

Dietary Adjustments for the Chronic Hypertensive Type two Diabetic-Nephropathy Patients Getting a Foothold in the Nephronic Syndrome By: Dr. Gary D. Goldberg, PhDClinical Professor of Medical Education, and ConsultantAngeles College of Nursing, Los Angeles, California [emailprotected] Moderate and/or severe protein restrictions may indeed, be proposed in chronic renal failure both to fight its symptoms and to slow its progression.In diabetic patients, whether insulin-dependent or non-insulin-dependent, have a chronic disease that has generally existed for a number of years before the onset of renal failure.Dietary protein restrictions are effective in the progression of diabetic nephropathy, but many such patients have been observing dietary recommendations.Usually the registry dietitian and/or treating physician will instruct the patient on the intake of both carbohydrates and fats.In addition, there is a growing population that areunwillingto give-up their eating habits and progress from mildly obese tomorbid obesity.Furthermore, when renal failure develops, the patient may get the strong impression that the different specialists managing his or her health have contradictory objectives and give opposing nutritional advice.It is highly important that the patientnot to imaginethat the diabetologist and the nephrologist are giving conflicting dietary directives when, in fact, most of the time their objectives converge. Notes:The registered nurse and/or nurse practitioner should communicate directly(e.g., add 15 min. of personalized teaching with your patient), understanding and having him and/or her repeat back the dietary information given and or explain through environmental aids that they understand and are willing to comply toward the life-style change and regiment Continue reading >>

Low-protein Diet For Diabetic Nephropathy: A Meta-analysis Of Randomized Controlled Trials

Low-protein Diet For Diabetic Nephropathy: A Meta-analysis Of Randomized Controlled Trials

Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials From the Division of Nephrology, No. 3 People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (YP and HMJ), and the Hemodialysis Center, Bao Shan Branch of No. 1 People's Hospital, Shanghai Jiao Tong University, Shanghai, China (LLG) Search for other works by this author on: From the Division of Nephrology, No. 3 People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (YP and HMJ), and the Hemodialysis Center, Bao Shan Branch of No. 1 People's Hospital, Shanghai Jiao Tong University, Shanghai, China (LLG) Search for other works by this author on: From the Division of Nephrology, No. 3 People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (YP and HMJ), and the Hemodialysis Center, Bao Shan Branch of No. 1 People's Hospital, Shanghai Jiao Tong University, Shanghai, China (LLG) Reprints not available. Address correspondence to HM Jin, Division of Nephrology, No. 3 People's Hospital, Shanghai Jiao Tong University School of Medicine, 280 Mo He Road, Shanghai 201900, China. E-mail: [email protected] . Search for other works by this author on: The American Journal of Clinical Nutrition, Volume 88, Issue 3, 1 September 2008, Pages 660666, Yu Pan, Li Li Guo, Hui Min Jin; Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials, The American Journal of Clinical Nutrition, Volume 88, Issue 3, 1 September 2008, Pages 660666, Background: A low-protein diet (LPD) has been proposed for many years to delay the progression of diabetic nephropathy. However, the efficacy of an LPD with respect to renal outcome is disputed. Objective: We aimed to determine the effect of an LP Continue reading >>

Nutritional Intervention For A Patient With Diabetic Nephropathy

Nutritional Intervention For A Patient With Diabetic Nephropathy

Nutritional Intervention for a Patient with Diabetic Nephropathy We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Nutritional Intervention for a Patient with Diabetic Nephropathy In recent years, several studies have reported that the prevalence of diabetes mellitus is increasing every year, and also the acute and chronic complications accompanying this disease are increasing. Diabetic nephropathy is one of chronic complications of diabetes mellitus, and food intake which is burden to kidney function should be limited. At the same time, diet restriction could deteriorate quality of life of patient with diabetic nephropathy. According to the results of previous studies, the aggressive management is important for delaying of the progression to diabetic nephropathy. Also, the implementation of a personalized diet customized to individuals is an effective tool for preservation of kidney function. This is a case report of a patient with diabetic nephropathy who was introduced to a proper diet through nutrition education to prevent malnutrition, uremia and to maintain blood glucose levels. Keywords: Diabetic nephropathies, Diabetes mellitus, Nutrition education According to a recently released 'The Korean Diabetes Research Report 2012' by Korean Diabetes Association, one out of ten adults has diabetes disease, two out of ten have the impaired fasting glucose which is stage of diabetes, and three out of ten adults are threatened by high Continue reading >>

Lipids, Protein Intake, And Diabetic Nephropathy - Em|consulte

Lipids, Protein Intake, And Diabetic Nephropathy - Em|consulte

Lipids, protein intake, and diabetic nephropathy H. Gin[1], V. Rigalleau[1], M. Aparicio[2] [1]Service de Nutrition-Diabtologie, Universit de Bordeaux II. [2]Service de Nphrologie, Universit de Bordeaux II. Progressive impairment of kidney function is one of the major problems in diabetic patients. Control of glycaemia and blood pressure is the main strategy for preventing or slowing impairment in renal function in this condition. However, contributing factors such as hyperlipidaemia and high protein intake have now been identified, and their control can be regarded as a complementary measure. The role of lipid abnormalities and hypercholesterolaemia in the pathogenesis of glomerular injury has been demonstrated in animal models, and a link between hypercholesterolaemia and diabetic nephropathy has been established in humans. To date, few intervention studies in diabetic patients have shown a slower decline in renal function. Nonetheless, in every study in which follow-up was long enough, cholesterol lowering had a beneficial effect on renal function. Although hypercholesterolaemia may not be the cause of renal injury, it represents an aggravating factor. High serum cholesterol seems to have a similar action on glomerular mesangial cells and endothelial cells. This appears to be analogous to the process of atherosclerosis, as mesangial cells possess binding sites for LDL and oxidised LDL, help recruit macrophages and secrete proliferative factors. Protein intake is another factor that can influence renal deterioration. Two meta-analyses have confirmed the beneficial effect of a low-protein diet in diabetic nephropathy, showing no adverse effects on the glycaemic control. Protein intake even seems to enhance the sensitivity of tissues and liver to insulin. Thus, there a Continue reading >>

Following A Diet For Diabetes And Kidney Disease

Following A Diet For Diabetes And Kidney Disease

Both of these illnesses can be difficult to manage alone, but can create even more stress when you have to manage both. Many Americans suffer from both conditions though and according to the End-Stage Renal Disease Incident and Prevalent Quarterly Update, approximately 37% of patients with ESRD have diabetes. (1) Diet becomes even more important for patients with both conditions. You will need to pay more attention to the amount of carbohydrates (sugars) that you eat. Carbohydrates can be found in many foods such as fruits, milk, breads, deserts and many drinks. Sodium remains important for both CKD and diabetic patients. Keeping your diet lower in sodium helps to lower blood pressure and reduce fluid retention. Protein is another nutrient that has enhanced importance and too much protein can be harmful for diabetic patients. It is important to talk to your dietician and nephrologist to determine the levels appropriate for your care. Another major change from only a kidney friendly diet is emphasis on eating on a routine and balancing out your meals and snacks. Peritoneal dialysis patients that also are diabetic need to be extra careful with their sugar levels, because dialysate solutions used to clean the body are normally sugar based solutions. Your care team will help determine what solution is best for you and help you adjust your diet to account for the extra sugar in the dialysate. Your care team should be aware of your status as a diabetes patient, however be proactive and make sure your dialysis care team is aware of your condition. The Following are examples of foods and drinks that are can be exchanged and are good for both diets: Fruits Good alternatives: Berries, grapes, cherries, apples, plums Avoid: Cantaloupe, mangos, kiwi, oranges, pomegranate Vegetables Continue reading >>

Foods Can Eat And Can Not Eat With Diabetic Nephropathy

Foods Can Eat And Can Not Eat With Diabetic Nephropathy

Foods Can Eat and Can Not Eat with Diabetic Nephropathy Patients with Diabetic Nephropathy often experience proteinuria and swelling; and some may also have combined with high blood pressure. As for the patients, proper dietary plan is very essential in protecting their kidneys and slowing down kidney condition aggravation. Dietary plan in Diabetic Nephropathy mainly include the follows: Take low protein food, but they can take adequate fish, lean meat, egg white or chicken to replenish the lost protein. These foods contain high quality protein which produce little wastes. Avoid high-potassium foods, like low sodium salt, sauce without salt, pickles, processed cans, ginseng powder, chicken powder, strong tea etc. Avoid High uric-acid food, like animal giblets, seafood, dried fish, beans etc. Foods that contain high amount of energy but low protein should be chosen, like potato, sweet potato and pumpkin should be considered. Low lipid consumptions. Olive oil and peanut oil have abundant monounsaturated fatty acids, which are good for human beings. In end-stage kidney disease, as kidneys fail to excrete potassium, and sodium. Foods like rape, spinach, tomato, kelp, banana and peach should be limited. If Diabetic Nephropathy patients have high blood pressure and swelling symptoms, they also need to limit salt intake. Foods rich in salt include pickles, salted eggs, salted vegetables, tomato sauce, barbecue, bacon and various seasons. Besides, fluids intake is also necessary to prevent the aggravation of swelling symptoms. Limit sugar intake, which need patients to keep far away from foods with high sugar like chocolate, orange juice, coconut, brown sugar and so on. The above is the general principles that Diabetic Nephropathy patients need to follow. Due to different illn Continue reading >>

Nutrition Recommendations And Interventions For Diabetes

Nutrition Recommendations And Interventions For Diabetes

A position statement of the American Diabetes Association Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention (see Table 1). MNT is also an integral component of diabetes self-management education (or training). This position statement provides evidence-based recommendations and interventions for diabetes MNT. The previous position statement with accompanying technical review was published in 2002 (1) and modified slightly in 2004 (2). This statement updates previous position statements, focuses on key references published since the year 2000, and uses grading according to the level of evidence available based on the American Diabetes Association evidence-grading system. Since overweight and obesity are closely linked to diabetes, particular attention is paid to this area of MNT. The goal of these recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions. This requires the use of the best available scientific evidence while taking into account treatment goals, strategies to attain such goals, and changes individuals with diabetes are willing and able to make. Achieving nutrition-related goals requires a coordinated team effort that includes the person with diabetes and involves him or her in the decision-making process. It is recommended that a registered dietitian, knowledgeable and skilled in MNT, be the team member who plays the leading role in providing nutrition care. However, it is important that all team members, including physicians and nurses, be knowledgeable about MNT and support its implementation. MNT, a Continue reading >>

Which Diet For Diabetic Patients With Chronic Renal Failure?

Which Diet For Diabetic Patients With Chronic Renal Failure?

Which diet for diabetic patients with chronic renal failure? Henri Gin, Service Nutrition et Diabtologie, Hpital du Haut-Lvque, F-33064 Pessac, France. Search for other works by this author on: Nephrology Dialysis Transplantation, Volume 14, Issue 11, 1 November 1999, Pages 25772579, Henri Gin, Vincent Rigalleau, Michel Aparicio; Which diet for diabetic patients with chronic renal failure?, Nephrology Dialysis Transplantation, Volume 14, Issue 11, 1 November 1999, Pages 25772579, Moderate or severe protein restriction may be proposed in chronic renal failure both to fight its symptoms and to slow its progression [ 1 , 2 ]. Diabetic patients, whether insulin-dependent or non-insulin-dependent, have a chronic disease that has generally existed for a number of years before the occurrence of renal failure. Dietary protein restriction is effective in the progression of diabetic nephropathy [ 3 5 ] but several such patients have already been observing dietary recommendations, usually involving carbohydrates and fats for some time and are sometimes unwilling to give up eating habits acquired over a long period. Furthermore, when renal failure develops, the patient may get the impression that the different specialists managing his health have contradictory objectives and give opposing nutritional advice. It is important for the patient not to imagine that the diabetologist and the nephrologist are giving conflicting dietary directives when, in fact, most of the time their objectives converge. Nutritional rules for patients with uncomplicated insulin-dependent diabetes Insulin-dependent diabetes is characterized by a loss of endocrine pancreas function; there is no interference with the peripheral action of insulin. In other words, there is no more, or practically no more produ Continue reading >>

Nutrition Therapy For Diabetic Nephropathy

Nutrition Therapy For Diabetic Nephropathy

, Volume 3, Issue5 , pp 412417 | Cite as Nutrition therapy for diabetic nephropathy Human observational studies report no association between protein intakes less than 20% of energy intake and the development of renal disease. With protein intakes greater than 20% of energy intake there is an association between protein with increased albumin excretion rate. Once albuminuria is present, intervention studies suggest a beneficial effect on renal function with a reduction of protein to 0.8 to 1.0 g/kg/d with microalbuminuria and to 0.8 g/kg/d with macroalbuminuria. Restriction of sodium to 2400 mg/d or possibly for some to 2000 mg/d assists in the control of hypertension. In macroalbuminuria, there may be additional benefits in lowering phosphorus intake to 500 to 1000 mg/d. There is no strong evidence to suggest benefit from vegetable or plant proteins over animal protein, but there is evidence for benefit on renal function, glucose, lipids, and blood pressure from weight-maintaining diets meeting guidelines for a healthy diet. Diabetic NephropathyProtein IntakeVegetable ProteinAlbumin Excretion RateVegetarian Diet These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Diabetic nephropathy (position statement). American Diabetes Association [no authors listed]. Diabetes Care 2003, 26(suppl 1):S94S98. Google Scholar The effect of intensive treatment of diabetes on the development and progression of long-term complications in IDDM. DCCT Research Group [no authors listed]. N Engl J Med 1993, 329:977986. Google Scholar Intensive blood-glucose control with sulph Continue reading >>

Diabetic Nephropathytreatment & Management

Diabetic Nephropathytreatment & Management

Diabetic NephropathyTreatment & Management Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Several issues are key in the medical care of patients with diabetic nephropathy. [ 20 , 21 ] These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases. A meta-analysis from the Cochrane Database shows a large fall in blood pressure with salt restriction, similar to that of single-drug therapy. [ 22 ] All diabetic patientsshould consider reducing salt intake at least to less than 5-6 g/d, in keeping with current recommendations for the general population, and may benefit from lowering salt intake to even lower levels. Reducing dietary salt intake may help slow progression of diabetic kidney disease. Renal replacement therapy may be necessary in patients with end-stage renal disease (ESRD). A 2012 post-hoc analysis of the data merged from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial and the Irbesartan Diabetic Nephropathy Trial (IDNT) in 1177 patients demonstrated that a low-sodium diet (24-h urinary sodium/creatinine ratio (mmol/g) < 121) enhanced the renoprotective and cardioprotective effect of angiotensin receptor blockers (losartan or irbesartan) in type 2 diabetic patients with nephropathy. Compared with higher sodium intake groups, the patients in the low-sodium group had better renal (by 43%) and cardiovascular (by 37%) outcomes. These improved outcomes in the low-sodium group underscore the importance of recent calls for population-wide intervention to reduce dietary salt intake, particularly in patients with diabetes and nephropathy treated with angiotensin receptor blockers. [ 23 ] In perso Continue reading >>

Dietary Approaches In The Management Of Diabetic Patients With Kidney Disease

Dietary Approaches In The Management Of Diabetic Patients With Kidney Disease

Dietary Approaches in the Management of Diabetic Patients with Kidney Disease Gang Jee Ko ,1,2 Kamyar Kalantar-Zadeh ,1,3,4 Jordi Goldstein-Fuchs ,5,6 and Connie M. Rhee 1,* 1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA 92868, USA; [email protected] (G.J.K.); [email protected] (K.K.-Z.) 2Department of Internal Medicine, Korea University, School of Medicine, Seoul 08308, Korea 1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA 92868, USA; [email protected] (G.J.K.); [email protected] (K.K.-Z.) 3Department of Medicine, Tibor Rubin Veteran Affairs Health System, Long Beach, CA 90822, USA 4Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA 5Sierra Nevada Nephrology Consultants, Reno, NV 89511, USA; [email protected] 6Department of Internal Medicine, University of Nevada Reno, School of Medicine, Reno, NV 89557, USA 1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA 92868, USA; [email protected] (G.J.K.); [email protected] (K.K.-Z.) 1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA 92868, USA; [email protected] (G.J.K.); [email protected] (K.K.-Z.) 2Department of Internal Medicine, Korea University, School of Medicine, Seoul 08308, Korea 3Department of Medicine, Tibor Rubin Veteran Affairs Health System, Long Beach, CA 90822, USA 4Los Angeles Biomedical Research Institute Continue reading >>

Kind-to-kidneys Meal Planning

Kind-to-kidneys Meal Planning

Help damaged filters function at their best Diabetes is challenging; kidney disease is challenging, says Vandana Sheth, RD, CDE, a Los Angeles dietitian and certified diabetes educator: "When you put the two together, that diagnosis can be overwhelming and pretty stressful." People with diabetes are used to meal plans that count carbohydrates and saturated fat, but kidney disease adds to the foods-to-monitor list, which are covered in this article. Healthy kidneys work hard to keep vital nutrients in your body and get rid of waste products you don't need. Every day, the two fist-sized organs that rest in the lower back on either side of your spine filter about 50 gallons of blood. Your kidneys expel toxins via urine and keep nutrients, such as salt and potassium, in perfect balance. When the kidneys are damaged, a potential long-term complication of diabetes, they lose their ability to filter the blood properly. That's dangerous because waste and excess fluid can't escape your body. A meal plan that takes this into consideration is important for people with decreased kidney function and those with kidney failure on dialysis. The nutrient protein is essential for building muscles and repairing tissues, but when your kidneys can't filter protein waste products such as urea from your body, you run the risk of these waste products building up to high levels. This, in turn, can cause serious health problems, from fatigue and loss of appetite to a decreased level of consciousness and coma. Because of this, many people with kidney disease limit the amount of protein they eat. Exactly how much protein is too much depends on a person's kidney function, and the specific daily allowance is usually recommended by a doctor or dietitian. Because you won't be eating as much of it, ex Continue reading >>

Nutritional Approach To Diabetic Nephropathy

Nutritional Approach To Diabetic Nephropathy

Received Date: August 13, 2015; Accepted Date: September 29, 2015; Published Date: October 5, 2015 Citation: Saxena A (2015) Nutritional Approach to Diabetic Nephropathy. Anat Physiol 5:181. doi:10.4172/2161-0940.1000181 Copyright: 2015 Saxena A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Diabetes is an important cause of renal disease . Diabetic nephropathy (DN) is characterized by albuminuria, which is usually accompanied by hypertension, progressive rise in proteinuria (albuminuria >0.5 g/24 h), and decline in renal function. Long term complications of diabetes are macrovascular disease (coronary heart disease), cerebrovascular disease, peripheral arterial disease and microvascular disease retinopathy and nephropathy. DN carries a 20- to 40-fold increased risk for cardiovascular (CV) mortality. To delay progression of DN to ESRD following measures are recommended a) good control of blood glucose, b) low-protein diet, c) control of hypertension, d) restriction of dietary salt, phosphorus and potassium in advanced cases and e) control of hyperfiltration, usually through angiotensin -converting enzyme (ACE) inhibitors or angiotensin-receptor blocking (ARB) agents. ACE inhibitors reduce proteinuria and glomerulosclerosis. Mangement of proteinuria with diet has shown that antiproteinuric effect is strongly dependent on dietary sodium restriction. Diabetic nephropathy ; Diabetes; Renal function ; Cardiovascular India among all the SAARC countries has become the diabetes capital of the world. Twenty to forty percent of type 2 diabetes patients having microalbuminuria progress to over Continue reading >>

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