title: Observation on renal outcomes in the Veterans Affairs Diabetes Trial.
abstract: OBJECTIVE
  The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, controlled trial of 1,791 patients with type 2 diabetes to determine whether intensive glycemic control would reduce cardiovascular events compared with standard control. The effect of intensive glycemic control and selected baseline variables on renal outcomes is reported.
  
  
  METHODS
  Baseline mean age was 60.4 years, mean duration of diabetes was 11.5 years, HbA(1c) was 9.4%, and blood pressure was 132/76 mmHg. The renal exclusion was serum creatinine >1.6 mg/dL. Renal outcomes were 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).
  
  
  RESULTS
  Intensive glycemic control did not independently reduce ACR progression but was associated with a significant attenuation in the progression of ACR in those who had baseline photocoagulation, cataract surgery, or both. The beneficial effect of intensive glycemic control increased with increasing BMI and with decreasing diastolic blood pressure (DBP). Intensive glycemic control was associated with less worsening of eGFR with increasing baseline ACR and insulin use. Baseline systolic blood pressure, triglycerides, and photocoagulation were associated with worsening of eGFR.
  
  
  CONCLUSIONS
  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 and on worsening of eGFR in those with high baseline ACR.
authors.affiliation: Department of Medicine, Edward Hines, Jr., VA Hospital, Hines, IL, USA. lily.agrawal@va.gov
authors.forename: Lily
authors.initials: L
authors.lastname: Agrawal
authors.forename: Nasrin
authors.initials: N
authors.lastname: Azad
authors.forename: Nicholas V
authors.initials: NV
authors.lastname: Emanuele
authors.forename: Gideon D
authors.initials: GD
authors.lastname: Bahn
authors.forename: Derrick G
authors.initials: DG
authors.lastname: Kaufman
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Moritz
authors.forename: William C
authors.initials: WC
authors.lastname: Duckworth
authors.forename: Carlos
authors.initials: C
authors.lastname: Abraira
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D003404:Creatinine / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
chemical_list: D007328:Insulin; D003404:Creatinine