Burnt-Out Diabetes: Impact of Chronic Kidney Disease Progression on the Natural Course of Diabetes Mellitus

Kamyar Kalantar-Zadeh, Stephen F. Derose, Susan Nicholas, Deborah Benner, Kumar Sharma, Csaba P. Kovesdy

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Many individuals with diabetic nephropathy, the leading cause of chronic kidney disease (CKD) in the United States, progress to stage 5 of CKD and undergo maintenance dialysis treatment. Recent data indicate that in up to one third of diabetic dialysis patients with a presumptive diagnosis of diabetic nephropathy, glycemic control improves spontaneously with the progression of CKD, loss of residual renal function, and the initiation of dialysis therapy, leading to normal-to-low hemoglobin A1c (<6%) and glucose levels, requiring cessation of insulin or other anti-diabetic medications. Potential contributors to this so-called "burnt-out diabetes" include decreased renal and hepatic insulin clearance, a decline in renal gluconeogenesis, deficient catecholamine release, diminished food intake (because of anorexia or diabetic gastroparesis), protein-energy wasting (with resultant loss of weight and body fat), and the hypoglycemic effects of dialysis treatment. Although the concept of "burnt-out diabetes" appears in sharp contradistinction to the natural history of diabetes mellitus, studying this condition and its potential causes and consequences, including the role of genetic factors, may lead to a better understanding of the pathophysiology of metabolic syndrome and diabetes mellitus in the CKD population and in many other individuals with chronic disease states associated with wasting syndrome that can confound the natural history of diabetes.

Original languageEnglish (US)
Pages (from-to)33-37
Number of pages5
JournalJournal of Renal Nutrition
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2009

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Chronic Renal Insufficiency
Disease Progression
Dialysis
Diabetes Mellitus
Diabetic Nephropathies
Kidney
Insulin
Wasting Syndrome
Gastroparesis
Gluconeogenesis
Anorexia
Natural History
Hypoglycemic Agents
Catecholamines
Adipose Tissue
Weight Loss
Hemoglobins
Chronic Disease
Therapeutics
Eating

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Nephrology

Cite this

Burnt-Out Diabetes : Impact of Chronic Kidney Disease Progression on the Natural Course of Diabetes Mellitus. / Kalantar-Zadeh, Kamyar; Derose, Stephen F.; Nicholas, Susan; Benner, Deborah; Sharma, Kumar; Kovesdy, Csaba P.

In: Journal of Renal Nutrition, Vol. 19, No. 1, 01.01.2009, p. 33-37.

Research output: Contribution to journalArticle

Kalantar-Zadeh, Kamyar ; Derose, Stephen F. ; Nicholas, Susan ; Benner, Deborah ; Sharma, Kumar ; Kovesdy, Csaba P. / Burnt-Out Diabetes : Impact of Chronic Kidney Disease Progression on the Natural Course of Diabetes Mellitus. In: Journal of Renal Nutrition. 2009 ; Vol. 19, No. 1. pp. 33-37.
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