Combined Diabetes-Renal Multifactorial Intervention In Patients With Advanced Diabetic Nephropathy (ADN)

"Study group will receive multifactorial intervention for advanced diabetic nephropathy:~Elements of multifactorial intervention:~1. BP control of \<130/80mmHg and renal protection with reduction of proteinuria to \<0.5g/day using therapy with ACE inhibitors and/or ARBs.~2. Tight glucose control with target of HbA1C of 7% and below using SMBG and Lantus/Apidra regimen.~3. Use of hypolipidemic therapy to achieve targets of LDL \< 70 mg/dl, HDL \> 40/50 mg/dl (M/F)and TG \< 200 mg/dl.~4. Patient enhanced self-management provided by combined diabetes-renal education curriculum.~5. Behavior and social intervention~6. Intense case management that includes close follow-up of visits, laboratory monitoring and other self-adherence behaviors carried out by clinical research coordinators."