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Clinical Diabetes 23:46-48, 2005
© American Diabetes Association ®, Inc., 2005

Case Study

Case Study: Man With Type 2 Diabetes and Stage 1 Kidney Disease on Atkins-Like Diet

Deborah Thomas-Dobersen, RD, MS, CDE and Lynn Casey, RD, CSR

The first 300 words of the full text of this article appear below.


   Presentation
 
C.S. is a 45-year-old Hispanic man with a 10-year history of type 2 diabetes. He has a glycated hemoglobin of 7.0% and a blood pressure of 130/80 mmHg, treated with an angiotensin-converting enzyme inhibitor for the past 2 years. He has stable background retinopathy and is a nonsmoker. His BMI has been 30 (height 5'10'', weight 210 lb) for the past year. However, lately, he has put himself on the latest high-protein diet (i.e., the Atkins diet).

His weight has dropped by 10 lb, his fasting serum triglyceride level has fallen from 185 to 130 mg/dl, and his blood pressure has decreased to 120/78 mmHg. His LDL cholesterol has remained stable at 102 mg/dl on a statin. His serum creatinine is 0.9 mg/dl, and his 24-hour urine shows a significant increase in microalbumuria from 100 mg/24 hours last year to the current 200 mg/24 hours. He has stage 1 chronic kidney disease indicating kidney damage, with a normal glomerular filtration rate (GFR) of 98 ml/min/1.73 m2.


   Questions
 

  1. Would the weight reduction, blood pressure, and lipid-lowering accomplished by this high-protein, low-carbohydrate diet be an acceptable choice for a patient who is at significant risk of cardiovascular disease?
  2. What are the recommendations of the American Heart Association (AHA), the National Kidney Foundation (NKF), the National Academy of Sciences, and the American Diabetes Association (ADA) regarding this type of diet for diabetes and/or weight loss?
  3. What has research revealed about appropriate levels of macronutrients for patients such as C.S.?


   Commentary
 
It is likely that microalbuminuria is the start of a continuum progressing to macroalbuminuria and proteinuria. Microalbuminuria predicts renal disease in diabetes (both type 1 and type 2) and relates to premature mortality. Microalbuminuria is also a marker for pronounced diabetic vascular disease (endothelial dysfunction and chronic low-grade inflammation). Abnormal albuminuria is a major . . . [Full Text of this Article]


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Copyright © 2005 by the American Diabetes Association.