Prediction of diabetic nephropathy: The need for a sweet biomarker.

Diabetes Mellitus Diabetic kidney disease Microalbuminuria Implication for health policy/practice/research/medical education: The ability to identify diabetic patients at high risk for progressive renal decline should be one of the priorities of nephrology community. Early identification may lead to improved clinical management, quality of life, and a decrease in the already high burden of morbidity. An ideal biomarker should be relatively inexpensive and readily measured either in serum or urine. Editorial D iabetes Mellitus is a common disease with an increasing prevalence worldwide. It is estimated that diabetes affects 25.8 million Americans, or 8.3% of the US population. According to the Centers for Disease Control, 11.3% of adults 20 years of age or older and 26.9% of individuals over the age of 65 have diabetes in the USA. The prevalence is even higher for Hispanics, Native Americans, and non-Hispanic blacks (1). The total estimated cost of pre-diabetes and diabetes in 2007 was $218 billion (2). The economic and social burdens of diabetes are undeniable. Chronic hyperglycemia can lead to serious complications in multiple organ systems, including the kidneys, eyes, nerves, and blood vessels. Early diagnosis and treatment of diabetes is crucial to prevent its complications. Even patients with good glycemic control can develop secondary complications of diabetes. The risk for death among people with diabetes is approximately twice that of age-matched individuals without diabetes (1). Diabetes is the leading cause of end stage renal disease, adult-onset blindness, and non-traumatic lower limb amputations. However, there is great variability among patients in the location, severity , and timing of the onset of diabetic complications. For example, one individual with uncon