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Listen to the audio and fill in the blanks with the exact words / phrases missing. You can play and pause the audios for a maximum number of 10 times.
You hear the lecture given by a senior surgeon on the role of diabetes in the end stage.
Role of Diabetes in the End Stage Renal Disease.
Of late, diabetes has become the (1) _________ ___________ of (2) ______ ________ renal disease, worldwide. This is due to the fact that diabetes, especially diabetes type two, is increasing.
Approximately, 45% of (3) _____ __________ receive dialysis in the US are diabetic. (4) _______ ___________ of diabetes and (5) ______ _____________ are crucial to prevent the progression towards (6) ______ _________.
Seen in a (7) _________ ___________ of type two diabetic patients and in many type one diabetics, the presence of (8) ____________________ is the early clinical evidence of diabetic neuropathy, defined as the appearance of low but (9) ___________ _______________ of albumin in the urine. The characteristics of (10) ____________ _____________ are a decline in (11) _____________ ______________ ratio, (12) _______________ __________ in (13) __________ __________ hypertension, and a (14) __________ __________ of cardiovascular morbidity.
Therefore, the evidence of microalbuminuria should trigger diagnosis for (15) ____________ ________ ________ and (16) ______________ _____________ to cope with all cardiovascular (17) ___________ _________ in diabetics type one and two.
The (18) _________ ___________ of diabetic neuropathy progresses slowly over the years. In type one diabetes, microalbuminuria occurs after (19) _________ ___________ and the (20) _____ ________ renal disease develops in (21) ____________________ of type one diabetes, whereas type two diabetics has a (22) _____________________. Very few patients with microalbumin urea progress to (23) ______________________ without intervention.
Approximately, 20% of patients of type two diabetes develop an (24) _______________________. However, due to the (25) _____________________ of type two diabetes patients compared to type one diabetes, the (26) ________________________ of patients on (27) _______________________ are type two diabetes. There are (28) ______________________________ which account for the pathophysiology of diabetic neuropathy, primarily (29) _______________________ and (30) ___________________________.
Changes in the kidney result in increased (31) _________ _________ ________ in diabetes, which is associated with (32) _________ _________ at the glomerulus. The next factor is the glucose that can increase the formation of (33) _________ _________ end products by inversibly binding to proteins in kidneys and circulation. Over the years, these formed advanced glycosylation (34) _________ _________ which stimulate the growth and (35) _________ _________ contributing to (36) _________ _________ ________.
Thirdly, (37) _________ _________ contributes to the advancement of diabetic neuropathy by narrowing the (38) _________ _________ in the glomerus, subsequently resulting in higher glomerular (39) _________ _________ while diagnosing.
Diabetic neuropathy. (40) _________ _________ of glucose intolerance and diabetes to distinguish patients who are at risk for developing microalbuminuria is suggested, especially if they have (41) _________ _________ for type two diabetes, such as lipid, (42) _________ _________ ________ or hypertension.
Therefore, the investigation of microalbuminuria presence should be performed at diagnosis in patients with type two diabetes, whereas in patients with type one diabetes, since microalbuminuria rarely occurs with (43) _________ _________ type one diabetes, the diagnosis should begin after (44) _________ _________ of disease. According to the findings, the (45) _________ ______________ develop during the (46) _________ _________ ________ of diabetes. Therefore, (47) _________ _________ ________ should be demonstrated when individualizing these suggestions.
The object of diabetic neuropathy therapy involves (48) _________ _________ ________. Tight glycaemic control is the keystone in the prevention and management of diabetic neuropathy. The United Kingdom Perspective Diabetes Study and Diabetes Control and Complications Trial have established that an (49) _________ _________ ________ can considerably decrease the risk of microalbuminuria and neuropathy development. Nonetheless, blood pressure control is (50) _________ _________ ________ in prevention and treatment.
