"As we expected, those with diabetes and kidney disease had a lot higher risk of mortality," said Afkarian.
"Clearly, we're not at the point of stopping type 2 diabetes," she said, "so the next question becomes, 'What happens if we can keep the kidneys healthy?'"
She said prevention efforts should focus on people who have diabetes but not kidney disease. "Try to control your risk factors to prevent kidney disease," she suggested. And, the biggest risk factor is uncontrolled blood sugar.
However, there also is a genetic component to developing kidney disease, she said. So, if you have those genes, you may develop kidney disease even if your blood sugar is well-controlled. But for most people with type 2 diabetes, controlling blood sugar levels can help prevent kidney disease, or at least slow its progression, she said.
Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, approved of the analysis. "It shows that once someone is sick, it's a bad marker," he said.
"We always have to emphasize much more on prevention. There's a nice correlation between A1C (a long-term measure of blood sugar control) and kidney disease. And people without high blood pressure tend to do better," he noted.
The problem, he said, is that it's often "a long time before people are diagnosed with type 2 diabetes, and when they are diagnosed, they're often undertreated, which leads to uncontrolled diabetes."
Zonszein said many people with type 2 diabetes who should be taking cholesterol and blood-pressure lowering medications aren't on them. Afkarian said people who have both type 2 diabetes and kidney
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