title: Remission of diabetic nephropathy in type 2 diabetic Asian population: role of tight glucose and blood pressure control.
abstract: BACKGROUND
  Asian has higher prevalence of diabetic nephropathy (DN) and end-stage renal disease when compared to Caucasian. No study to date has evaluated whether multifactorial intervention was associated with remission of microalbuminuria in type 2 diabetic Asian population. We evaluated the effect of tightly controlling multiple factors on the remission of DN in type 2 diabetic Chinese with microalbuminuria.
  
  
  METHODS
  A longitudinal cohort study was collected 587 type 2 diabetic patients with microalbuminuria. Cohort members received intensified treatment to meet the following ADA recommended goals: HbA1c <7%, systolic blood pressure (SBP) <130mmHg, diastolic blood pressure <80 mmHg, low-density lipoprotein cholesterol <100mgdL(-1) , triglyceride < 150mgdL(-1) , high-density lipoprotein cholesterol >40mgdL(-1) for men and >50mgdL(-1) for women. Remission of microalbuminuria was defined as shift of albumin-creatinine ratio from mircoalbuminuria to normoalbuminuria.
  
  
  RESULTS
  During the 4·5-year period, 210 (35·8%) patients achieved remission to normoalbuminuria. A significant association was found between the achievement of ADA goals, including HbA1c < 7% [hazard ratio (HR)=1·345; 95% confidence interval (CI), 1·010-1·792; P=0·04] and SBP <130mmHg (HR, 1·516; 95% CI, 1·100-2·089; P=0·01) and remission of microalbuminuria. The intensive SBP control (<120mmHg) was significantly associated with remission of microalbuminuria (HR, 2·076; 95% CI, 1·347-3·198; P<0·001).
  
  
  CONCLUSIONS
  The remission of DN could be achieved under multifactorial intervention. Therapeutic focus on remission by tight glycemic and blood pressure control should be considered in Asian population with diabetes and microalbuminuria.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taichung, Taiwan.
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Hsieh
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hsieh
authors.forename: Tzu-Jung
authors.initials: TJ
authors.lastname: Cho
authors.forename: Jung-Fu
authors.initials: JF
authors.lastname: Chen
authors.forename: Shi-Dou
authors.initials: SD
authors.lastname: Lin
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Shih-Te
authors.initials: ST
authors.lastname: Tu
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People / Q000235:genetics; D001786:Blood Glucose / Q000502:physiology*; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000235:genetics; D003928:Diabetic Nephropathies / Q000097:blood / Q000235:genetics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents