The difficult management of patients with type 2 diabetes and renal disease: from diagnosis to treatment

Abstract

The prevalence of type 2 diabetes mellitus and arterial hypertension is on the rise in western countries and chronic kidney disease is certainly one of their most harmful complications. This condition greatly complicates patient management. The clinician needs to wisely identify the best diagnostic algorithm and carefully balance potential risks and benefits of each therapeutic decision.Even when recommended therapeutic targets can be achieved, often a challenging task in clinical practice, residual cardiovascular and renal risk remains unacceptably high for these patients.Here we present the case of a 72-year old woman, with arterial hypertension and diabetes mellitus type 2. Despite the long clinical history of the patient, being treated for over 20 years,blood pressure and metabolic control were not satisfactory. The authors trace the patient’s treatment pathway, following the different clinical questions that led them to the modification of the patient’s therapy. The new therapy is based on chlorthalidone, sitagliptin, a combinationtherapy of ezetimibe / simvastatin, and metformin. [Article in Italian]