A 63-year-old woman has Type 2 diabetes mellitus, which is well controlled. Her physical examination is positive for peripheral neuropathy in the feet and non-proliferative retinopathy. A urinalysis is positive for proteinuria. Which of the following treatments is most likely to attenuate the course of renal disease?: (A) calcium channel blockers, (B) ACE inhibitors, (C) hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) inhibitors, (D) dietary carbohydrate restriction
Answer is B. It is very likely that control of hypertension and excellent glucose control will slow the development and course of renal disease in Type 2 diabetes mellitus. ACE inhibitors seem to decrease proteinuria and slow progression of renal disease. As renal function deteriorates, limiting dietary protein intake can also be beneficial. Calcium channel blockers have no extra effect beyond their antihypertensive effect.