title: Achievement of therapeutic targets in patients with diabetes and chronic kidney disease: insights from the Associazione Medici Diabetologi Annals initiative.
abstract: BACKGROUND
  Chronic kidney disease (CKD) entails a worse cardiovascular outcome. The aim of our work was to study the relationship between CKD and the achievement of recommended targets for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) in a real-life sample of patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  We analysed a sample of 116 777 outpatients from the Network of the Italian Association of Clinical Diabetologists; all patients had T2DM and at least one measurement of HbA1c, LDL-c, BP, serum creatinine and albuminuria in the year 2010. The outcome was the achievement of HbA1c, LDL-c and BP values as recommended by International Guidelines.
  
  
  RESULTS
  In the entire sample, the mean value of HbA1c was 7.2 ± 1.2%, of LDL-c was 102 ± 33 mg/dL and of BP was 138/78 ± 19/9 mmHg. CKD and its components were associated with poor glycaemic and BP control, notwithstanding greater use of glucose and BP-lowering drugs, while no association was found with LDL-c values. Factors independently related to unsatisfactory glycaemic control included female gender, body mass index, duration of disease and high albuminuria. Men, older people and those taking statins were more likely to reach LDL-c target levels. Male gender, age and high albuminuria strongly affected the achievement of BP targets.
  
  
  CONCLUSIONS
  CKD or its components, mainly high albuminuria, are associated with failure to reach therapeutic targets, especially for HbA1c and BP, despite a greater use of drugs in patients with T2DM.
authors.affiliation: Department of Medical Sciences, IRCCS Casa Sollievo Della Sofferenza, S. Giovanni Rotondo, FG, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Cosmo
authors.affiliation: Università Degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.affiliation: Department of Medical Sciences, IRCCS Casa Sollievo Della Sofferenza, S. Giovanni Rotondo, FG, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pacilli
authors.affiliation: Diabetes and Metabolism Unit, ASL Turin 5, Chieri, TO, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Giorda
authors.affiliation: Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ceriello
authors.affiliation: Department of Clinical and Experimental Medicine, 2nd University of Naples, Naples, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gentile
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Russo
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, CH, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Rossi
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, CH, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.affiliation: Associazione Medici Diabetologi, Roma, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.affiliation: Diabetes Unit, ASL Della Romagna, Ravenna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolo
authors.affiliation: Università Degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; C517652:hemoglobin A1c protein, human
keywords: antihypertensive treatment; arterial hypertension; cardiovascular risk factors; diabetic nephropathy; hypercholesterolaemia