Diabetes research studies have shown that preventing or slowing kidney disease can be achieved by:

* Using certain types of blood pressure medicine
* Eating a moderate-protein diet
* Intensive management of blood glucose.

An example of an effective ARB is losartan, which has also been shown to protect kidney function and lower the risk of cardiovascular events (such as a stroke or heart attack). Another example of an ARB used to treat diabetic nephropathy is irbesartan.

Blood Pressure Medicines

Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure (antihypertensive drugs) can slow the progression of kidney disease significantly. Two types of blood pressure medication have proven effective in slowing the progression of kidney disease:

* Angiotensin-converting enzyme inhibitors (ACE inhibitors)
* Angiotensin II receptor blockers (ARBs).

Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic is useful. Other drugs may also be needed, such as:

* Beta blockers
* Calcium channel blockers
* Other high blood pressure medications.

Moderate-Protein Diets

In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that people with kidney disease caused by diabetes consume the recommended dietary allowance (RDA) for protein, but avoid high-protein diets. For people with greatly reduced kidney function, a diet containing reduced amounts of protein may help delay the onset of kidney failure. Anyone following a reduced-protein diet should work with a dietitian to ensure adequate nutrition.

Intensive Management of Blood Glucose

Diabetes and Kidney Disease: An Overview Preventing and Slowing Kidney Disease Dialysis and Transplantation

Antihypertensive drugs and low-protein diets can slow kidney disease when significant nephropathy is present. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with type 1 and type 2 diabetes, especially for those in early stages of nephropathy.

Intensive management is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes:

* Testing blood glucose frequently
* Administering insulin frequently throughout the day on the basis of food intake and exercise
* Following a diet and exercise plan
* Consulting a healthcare team frequently.

Some people use an insulin pump to supply insulin throughout the day.

A number of studies have pointed to the beneficial effects of intensive management. One study involved 1,441 participants who had type 1 diabetes. Researchers found a 50 percent decrease in both development and progression of early diabetic kidney disease in participants who followed an intensive regimen for controlling blood glucose levels. The intensively managed patients had average blood glucose levels of 150 milligrams per deciliter — about 80 milligrams per deciliter lower than the levels observed in the conventionally managed patients.