Intensive Glycemic Control Does Not Improve Renal Outcome

But nephropathy progression is decreased in patients with worse microvascular disease

FRIDAY, July 29 (HealthDay News) -- In older patients with type 2 diabetes, intensive glycemic control does not improve renal disease progression, but it is associated with reduction in nephropathy progression in patients with worse microvascular eye disease, higher body mass index (BMI), and lower diastolic blood pressure (DBP), according to a study published online July 20 in Diabetes Care.

Lily Agrawal, M.D., from the Edward Hines Jr. Veteran Affairs Hospital in Hines, Ill., and colleagues investigated the effect of intensive glycemic control on renal outcomes in 1,791 participants with type 2 diabetes from the Veteran Affairs Diabetes Trial. Participants were 60.4 years on average, with mean duration of diabetes of 11.5 years, hemoglobin A1c of 9.4 percent, and blood pressure of 132/76 mm Hg. Patients with serum creatinine levels higher than 1.6 mg/dL were excluded from the study. Sustained worsening of the urine albumin-to-creatinine ratio (ACR) and sustained worsening by one or more stages in the estimated glomerular filtration rate (eGFR) were the main renal outcome measures.

The investigators found that intensive glycemic control correlated with significant attenuation in the progression of ACR in patients who had baseline photocoagulation, cataract surgery, or both, However, it did not independently reduce ACR progression. The positive effect of intensive glycemic control increased with decreasing DBP and increasing BMI. Intensive glycemic control correlated with less worsening of eGFR with increasing baseline insulin use and ACR; whereas, baseline systolic blood pressure, triglycerides, and photocoagulation were associated with worsening of eGFR.

"Intensive glycemic control had no significant effect on the progression of renal disease in the whole cohort but was associated with some protection against increasing ACR in those with more advanced microvascular disease, lower baseline DBP, or higher baseline BMI," the authors write.

The study medication and financial support was provided by Sanofi-Aventis, GlaxoSmithKline, Novo Nordisk, Roche, Kos Pharmaceuticals, and Amylin.

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