Research in complications
The group is dedicated to studies of diabetic micro- and macrovascular complications with a special focus on diabetic nephropathy. The research is devoted to the prevention and understanding of this devastating complication as well as to improvement of the prognosis for the patients suffering from diabetic nephropathy. These patients have an increased cardiovascular morbidity and mortality and as the renal prognosis has improved, the prognostic importance for the patients and the research focus for the group on cardiovascular complications have increased.
The short term goals are:
A) Improved ability to identify type 1 and type 2 diabetic patients with a high risk for development and progression of diabetic nephropathy by evaluation of putative non-genetic and genetic risk factors/markers in prospective observational studies, genetic association and family studies. Non-genetic risk factors of particular interest are at present new biomarkers. Several hundreds genetic polymorphisms in many different pathways have been identified and are awaiting further analysis.
B) Improved treatment of diabetic nephropathy by more effective blockade of the renin angiotensin aldosterone system, by evaluation of the effect of renin inhibition, the optimal dose of ACE inhibitors, angiotensin receptor blockers, blockade of aldosterone and their combination.
C) Characterization of genetic and non-genetic cardiovascular risk factors in type 1 and type 2 diabetic patients. Prospective observational studies with extensive cardiovascular examinations will determine the incidence and characteristics of cardiovascular complications and the prognostic and predictive impact of the risk factors/markers. In addition NT-proBNP is planned to be implemented as a prognostic marker in type 2 diabetic patients with elevated urinary albumin excretion.
D) Evaluation of the usefulness of gene expression at the mRNA level and proteomic patterns in serum and urine as a way to discriminate between patients with normo- micro- and macroalbuminuria.
Our intermediate goals are:
A) Enable identification of high risk individuals for initiation and progression of diabetic nephropathy with application of gene expression at the mRNA level and proteomic patterns in serum and urine
B) Investigation of new treatment modalities in diabetic nephropathy are planned (soludexide, AGE cross link breakers) as well as further explorations of the optimal way to block the RAAS.
C) Evaluation of the prognostic value of cardiovascular examinations (MR studies, echocardiography, exercise ECG, distal blood pressure measurements and 24 hour blood pressure patterns)
D) Improved understanding of the pathophysiology of diabetic micro and macroangiopathy.
The long-term goal is prevention of diabetic nephropathy through early identification of high risk individuals and application of individually designed treatment based on genetic and non-genetic characterization of the patients. For patients suffering from diabetic nephropathy the goal is identification of effective cardio- and renoprotective treatment maintaining or normalising renal function and avoiding development of cardiovascular complications.