title: Prevention of microalbuminuria using early intervention with renin-angiotensin system inhibitors in patients with type 2 diabetes: A systematic review.
abstract: OBJECTIVE
  Early prevention of diabetic nephropathy by way of blocking the renin-angiotensin system (RAS) in patients with normoalbuminuria seems rational, but trials have so far shown conflicting results. The present meta-analysis was undertaken to investigate if such treatment can prevent development of microalbuminuria.
  
  
  METHODS
  We searched MEDLINE, EMBASE and the Cochrane Library (2 June 2014) for randomised controlled trials, with a population of patients with type 2 diabetes and normoalbuminuria, comparing angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) to placebo. Studies had to have at least 50 participants in each arm and one year of follow-up. Random and fixed effect models were performed as well as trial sequential analysis.
  
  
  RESULTS
  Six trials were included in the analysis (n=16,921). Overall risk of bias was variable. In a fixed model analysis ACE or ARB treatment was superior to placebo in relation to prevention of development of microalbuminuria, risk ratio 0.84 (95% confidence interval (CI) 0.79-0.88) p<0.001, I(2)=23%, similar to random model results. Treatment also showed a trend towards a reduction in all-cause mortality(p=0.07).
  
  
  CONCLUSIONS
  We conclude that in patients with type 2 diabetes and normoalbuminuria, early intervention with ACEis or ARBs reduces the risk for development of microalbuminuria.
authors.affiliation: Steno Diabetes Center, Denmark frip@steno.dk.
authors.forename: Frederik
authors.initials: F
authors.lastname: Persson
authors.affiliation: Steno Diabetes Center, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Lindhardt
authors.affiliation: Steno Diabetes Center, Denmark Institute for Clinical Medicine, University of Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.affiliation: Faculty of Health Sciences, University of Aarhus, Denmark Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
mesh_terms: D000419:Albuminuria / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D017594:Publication Bias; D012084:Renin-Angiotensin System
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Type 2 diabetes; diabetic nephropathy; microalbuminuria; renin angiotensin system; review