Kidney disease, thought to be unstoppable in many people with type 1 diabetes, has been reversed with the help of nature, early detection, and tight blood sugar control.
About a third of the 1.5 million patients with type 1 diabetes eventually need a kidney transplant, or must spend hours every other day hooked up to a dialysis machine. The new findings provide hope that, when diabetes is found early and treated aggressively, patients can avoid such drastic treatments.
“In the earliest stages, we found that kidney injury is still a dynamic process that can either get worse or get better – even revert back to normal,” says Bruce Perkins, an endocrinology fellow at Harvard Medical School.
Some 14.5 million other people, who suffer from the more common type 2 diabetes, also develop kidney problems. “Results from research on type 1 generally apply to type 2,” Perkins notes. “We assume that will be true in this case, but we won’t know until we do more studies.”
The earliest sign of diabetic kidney disease is detection of small amounts of protein that leak from blood into the urine. Once it appears, doctors generally believe that it’s only possible to postpone, but not prevent, kidney disease.
The research, done by Perkins and his colleagues at Joslin Diabetes Center in Boston, could change all that.
Perkins and his colleagues studied 386 patients who had protein leakage into their urine for two years. They followed them for six more years and found that the disease reverses itself under certain conditions. The conditions included early detection and good control of blood sugar with insulin injections, as well as low blood pressure, cholesterol, and blood fats (triglycerides). “Surprisingly, the leakage of protein subsided in more than half (58 percent) of them. Those diagnosed earliest and with low cholesterol did the best.” By low cholesterol, Perkins means about 200 milligrams per decaliter or less.
High cholesterol is known to be bad for patients with advanced kidney disease, but how important it is in the earliest stages of the disease was not fully appreciated until now.
Physicians often treat diabetic kidney disease with certain blood pressure drugs, like ACE inhibitors, but Perkins and his colleagues found they had no effect on the people in their study. “We saw the same effect in regression of the disease whether they took these drugs or not,” Perkins says.
What is happening to make the disease go away? “We infer that specific mechanisms of repair exist in the kidney that enable the organ to repair itself in the earliest stages,” Perkins answers. “When we understand these mechanisms better, we can develop more effective treatments for preventing serious kidney disease. In the meantime, our study highlights the need for frequent screening and early intervention.”
Perkins and his colleagues published their findings in the June 5 issue of the New England Journal of Medicine. In an editorial in the same issue, Eberhard Ritz of the University of Heidelberg in Germany notes that, “It stands to reason these landmark studies will heighten physicians’ awareness of the importance of screening (for kidney disease) to permit aggressive early intervention, particularly intervention that leads to tight (blood sugar) control.”
Ritz also notes that successes in treating type 1 diabetes often can be used to help type 2 diabetics. “This is important,” he says, “because the World Health Organization estimates that by 2010, 200 million people will have diabetes. It is certainly no exaggeration to state that from a public health perspective, appropriate management of this threat will be a major challenge to medicine.”