Researchers found similar effects on human mesangial cells in hyperglycemic culture in vitro (Thornalley 2003). The primary intervention was the prevention of thiamine deficiency and induction of TK expression with consequent activation of the reductive PPP shunt (Thornalley 2003). The effects were achieved by increasing the dietary availability of thiamine to diabetic rats by as little as 20 times the minimum daily allowance, yet this was sufficient to prevent thiamine deficiency (Thornalley 2003). Thiamine deficiency exacerbated the development of diabetic nephropathy, thus the researchers proposed that clinical diabetic subjects should avoid becoming thiamine deficient, even weakly so, and that high-dose thiamine repletion should be considered for therapy to prevent the development of clinical diabetic nephropathy (Thornalley 2003).

             Diabetic nephropathy is more prevalent among African Americans, Asians, and Native Americans than Caucasians (Zelmanovitz 2005). Moreover, among patients starting renal replacement therapy, the incidence of diabetic nephropathy doubled from 1991-2001, however the rate of increase has slowed down (Zelmanovitz 2005). The reason for the slow down is probably due to the adoption in clinical practice of several measures that contribute to the early diagnosis and prevention of diabetic nephropathy, which thereby decreases the progression of established renal disease (Zelmanovitz 2005). A ten-year follow-up revealed the risk of diabetic nephropathy was 29 times greater in patients with type 2 diabetes with UAE values > 10 (micro)g/min, and the same held true for patients with type 1 diabetes (Zelmanovitz 2005). This favors the concept that the risk associated with UAE is a continuum, as is the case with blood pressure levels (Zelmanovitz 2005). .

             Treatment of hypertension dramatically reduces the risk of cardiovascular and microvascular event in patients with diabetes, in fact hypertension is common in diabetic patients, even when renal involvement is not present (Zelmanovitz 2005).