title: Intensive glucose control improves kidney outcomes in patients with type 2 diabetes.
abstract: The effect of intensive glucose control on major kidney outcomes in type 2 diabetes remains unclear. To study this, the ADVANCE trial randomly assigned 11,140 participants to an intensive glucose-lowering strategy (hemoglobin A1c target 6.5% or less) or standard glucose control. Treatment effects on end-stage renal disease ((ESRD), requirement for dialysis or renal transplantation), total kidney events, renal death, doubling of creatinine to above 200 μmol/l, new-onset macroalbuminuria or microalbuminuria, and progression or regression of albuminuria, were then assessed. After a median of 5 years, the mean hemoglobin A1c level was 6.5% in the intensive group, and 7.3% in the standard group. Intensive glucose control significantly reduced the risk of ESRD by 65% (20 compared to 7 events), microalbuminuria by 9% (1298 compared to 1410 patients), and macroalbuminuria by 30% (162 compared to 231 patients). The progression of albuminuria was significantly reduced by 10% and its regression significantly increased by 15%. The results were almost identical in analyses taking account of potential competing risks. The number of participants needed to treat over 5 years to prevent one ESRD event ranged from 410 in the overall study to 41 participants with macroalbuminuria at baseline. Thus, improved glucose control will improve major kidney outcomes in patients with type 2 diabetes.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia. vperkovic@georgeinstitute.org.au
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Hiddo Lambers
authors.initials: HL
authors.lastname: Heerspink
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Stephen
authors.initials: S
authors.lastname: MacMahon
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cooper
authors.forename: Pavel
authors.initials: P
authors.lastname: Hamet
authors.forename: Michel
authors.initials: M
authors.lastname: Marre
authors.forename: Carl Erik
authors.initials: CE
authors.lastname: Mogensen
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000517:prevention & control; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human