Does Losartan Prevent Progression of Early Diabetic Nephropathy in American Indians With Type 2 Diabetes?

Approximately 346 million individuals worldwideand 25.8 million individuals in the U.S. have di-abetes (1,2). The high prevalence of diabetesresults in a persistently increased prevalence of diabetic nephropathy, which is the leading cause of kidney failure and premature cardiovascular mortality (3). In the U.S., diabetic nephropathy is represented disproportion-ately in several minority populations including American Indians (4). Of the American Indian tribes in which type 2 diabetes develops at an alarming rate in children as a re-sult of childhood obesity, the Pima Indians tend to have even higher rates of diabetic nephropathy (up to 65%; age-group 45–74 years) and concomitant end stage renal dis-ease (ESRD; as high as 3.5 times) compared with white Americans (5–7). Fasting hyperglycemia and hemoglobin A1C are strong predictors of albuminuria in Pima Indians. Research has established that strict control of plasma glucose in the prediabetic stage can preempt a diagnosis of