Historical Aspects

In the pre-insulin era, patients who developed complications related to diabetes would be type 2 diabetics because type 1 patients would simply not survive long enough. As early as the 19th century, it was recognized that urine of diabetic patients contained abnormal amounts of coagulable matters, likely to be proteins (6,7).

The French physician Rayer (8) also described in 1839 the characteristic renal hypertrophy that was rediscovered only in the 1970s, and German physicians identified renal involvement in diabetes: when glucosuria would disappear due to a severe decrease in renal function, patients would quite often have heavy proteinuria and edema (6).

Pathologists were also aware of the typical diabetic kidney and quite often Arman Epstein lesions were identified because of lack of treatment (9). However, the understanding of the disease was changed by the observation in 1936 by Kimmelstiel and Wilson (10) who found glomerular lesions in eight patients, all of whom were likely to be type 2 diabetic patients with renal impairment and hypertension. Kimmelstiel and Wilson clearly understood that the renal disease was due to diabetes. However, for many years such complications were still considered rare in type 2 diabetes and the clinical course was not considered malignant (benign diabetes) (11).

In the last few years, there has been a change in treatment strategy, partly because of the UK Prospective Diabetes Study (UKPDS) that clearly negated the concept that glycemic treatment with sulfonylurea (SU) agents and metformin and even insulin, could be deleterious (12,13). The opposite is rather the case although with some reservations (14). Still results from the DART study suggest some problems with SU treatment (15). However, no comparison was done comparing old and new SU. Now recent evidence favors use of newer SU (14,16).

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