Diabetes poses a threat to the proper functioning of the kidneys. A study has identified spies that reveal who is at risk
It is now proven that diabetes, especially if not controlled, becomes a threat to the kidneys over time. Suffice it to say that, on a global scale, metabolic disease is the leading cause of kidney failure in the world and is responsible for 25-40 percent of dialysis cases.
For this, in people with diabetes, it is necessary to be able to understand how to recognize who is most at risk of developing kidney problems and then implement specific treatments to prevent this situation. An Italian research, presented at the Congress of the European Association for Diabetes Studies (EASD) opens the way to "personalized" treatments on this front.
Here are the "spies" who can help us
According to studies, in almost four out of ten cases suffering from type 2 diabetes, the one that appears in adults and is linked to overweight and poor physical activity, has a progressive reduction in glomerular filtrate (GFR), a parameter of renal function.
In recent years, the treatment of patients with DT2 and reduced renal function has changed profoundly, thanks to the availability of new pharmacological treatments for hyperglycemia that should be implemented as soon as possible in those who really need it. But these medicines must be used correctly. How can it be done?
Some biomarkers have recently been proposed as possible "predictors" of the onset of renal failure (low GFR) in diabetic patients. "We therefore went to evaluate – explains Maria Giovanna Scarale, Laboratory of Diabetology and Endocrinology of the IRCCS Casa Sollievo della Sofevole in San Giovanni Rotondo – the predictive ability of low GFR in patients with diabetes, of some metabolic products that can be measured in the blood".
The research was conducted on 861 diabetic patients enrolled in the Gargano Mortality Study 2 (GMS2) and the Gargano Mortality Study 1 (GMS1), two studies coordinated by Vincenzo Trischitta with the contribution of Salvatore De Cosmo. 188 blood metabolites were measured in these subjects. The validated metabolites were used together to create a metabolite risk score or MetScore which was used as a tool to improve the prediction of reduced GFR of a clinical model consisting of readily available variables (age, sex, BMI, hemoglobin glycate and albumin / creatinine).
“The results of the study – explains Dr. Scarale – show that the MetScore improves the ability of the clinical model to predict the reduction of GFR, that is the deterioration of renal function. The MetScore makes it possible to identify with greater precision those with diabetes who will suffer from worsening renal insufficiency ". Although the dosage of metabolites can currently only be performed in highly specialized laboratories, the result of this study contributes to the realization of precision medicine, improving the identification of patients with diabetes at risk for renal dysfunction on which to concentrate the maximum of available resources. , thus optimizing prevention interventions.
At the moment these are only initial studies. But the hope is that the measurement of the levels of some metabolites and especially their combined use, increases the ability given by the clinical characteristics of individual patients (clinical model) to predict which of them is at risk of low glomerular filtrate.
More precisely, the addition of metabolites has improved the predictive ability of the clinical model in over 40 percent of patients, but, as mentioned, it takes time before talking about the use of this system. "The study of the colleagues of San Giovanni Rotondo is part of the precious research aimed at understanding in advance who is useful and necessary to intervene to prevent the development of diseases or complications in the logic of precision medicine – comments Agostino Consoli, president-elect of the Italian Society of Diabetology (SID). This is fundamental for the healthcare of the future where the limited resources available will have to be "concentrated" on those people in whom their application can really make a difference ".