Predictors of incident albuminuria in people with newly diagnosed Type 2 diabetes mellitus and prediabetes depending on smoking status and cardiometabolic profile.

The number of people suffering from diabetes has increased out of proportion. A leading UK charity working with people with diabetes, Diabetes UK, suspects that one in ten people over the age of 40 in the UK suffers from it. Its 2019 data suggests that almost 3.8 million people in the UK are living with diabetes, 90% of them with type 2. Alarmingly, almost 1 million more people living with diabetes without having had a diagnosis made, which essentially means they are more likely to present with complications. The total number of people with this condition is around 4.8 million. This figure was around 1.7 million in 1997. Diabetes UK predicts that this figure will rise to around 5.5 million by 2030. One in three of them will have already developed diabetic complications including diabetic kidney disease (DKD). Therefore, early diagnosis and aggressive management of risk factors are the key priorities for the health service. In the UK, a National Diabetes Prevention Programme (NDPP) is implemented in 2016, to delay the progression of prediabetes to diabetes.
DKD is a leading cause for End-stage Kidney Disease when the only way to survive is to have dialysis. Renal registry UK data 2018 suggests that annually almost 8000 new patients are registered for dialysis. Each dialysis cost the NHS approximately £22000 per annum. Over and above, multiple studies have shown that DKD is also an independent risk factor for heart attack and stroke. It is a chronic condition which usually starts with leakage of a protein, called albumin, in the urine. If the leakage of protein in the urine can be detected and managed appropriately at an early stage of disease trajectory, a body of evidence suggest that the progression can be halted and, in some cases, can be reversed. The key is early detection and multifactorial intervention which means reduction of all the risk factors. Although managing glucose is one of the most effective interventions but other risk factors must not be ignored. Exercise, dietary modifications and smoking cessation are also important interventions that can halt its progression. The public health impact of multifactorial intervention to prevent the prevalence and progression of DKD will be substantial. It will not only prevent end-stage kidney disease and the need for dialysis, but also will reduce the risk of diabetic peripheral neuropathy and amputations, blindness due to diabetic eye disease, heart attack and stroke.