Role of Intensive Glucose Control in Development of Renal End Points in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis | Nephrology | JAMA Internal Medicine | JAMA Network
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Review
May 28, 2012

Role of Intensive Glucose Control in Development of Renal End Points in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis

Author Affiliations

Author Affiliations: Department of Internal Medicine (Drs Coca, Krumholz, and Parikh) and School of Public Health (Dr Krumholz), Yale University School of Medicine, and Robert Wood Johnson Clinical Scholars Program and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (Dr Krumholz), New Haven, Connecticut. Clinical Epidemiology Research Center, Veterans Affairs Connecticut, West Haven (Drs Coca and Parikh); Departments of Internal Medicine, Case Western Reserve University, and Veterans Affairs Medical Center, Cleveland, Ohio (Dr Ismail-Beigi); and Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland (Dr Haq).

Arch Intern Med. 2012;172(10):761-769. doi:10.1001/archinternmed.2011.2230
Abstract

Background Aggressive glycemic control has been hypothesized to prevent renal disease in patients with type 2 diabetes mellitus. A systematic review was conducted to summarize the benefits of intensive vs conventional glucose control on kidney-related outcomes for adults with type 2 diabetes.

Methods Three databases were systematically searched (January 1, 1950, to December 31, 2010) with no language restrictions to identify randomized trials that compared surrogate renal end points (microalbuminuria and macroalbuminuria) and clinical renal end points (doubling of the serum creatinine level, end-stage renal disease [ESRD], and death from renal disease) in patients with type 2 diabetes receiving intensive glucose control vs those receiving conventional glucose control.

Results We evaluated 7 trials involving 28[[nbsp]]065 adults who were monitored for 2 to 15 years. Compared with conventional control, intensive glucose control reduced the risk for microalbuminuria (risk ratio, 0.86 [95% CI, 0.76-0.96]) and macroalbuminuria (0.74 [0.65-0.85]), but not doubling of the serum creatinine level (1.06 [0.92-1.22]), ESRD (0.69 [0.46-1.05]), or death from renal disease (0.99 [0.55-1.79]). Meta-regression revealed that larger differences in hemoglobin A1c between intensive and conventional therapy at the study level were associated with greater benefit for both microalbuminuria and macroalbuminuria. The pooled cumulative incidence of doubling of the serum creatinine level, ESRD, and death from renal disease was low ([[lt]]4%, [[lt]]1.5%, and [[lt]]0.5%, respectively) compared with the surrogate renal end points of microalbuminuria (23%) and macroalbuminuria (5%).

Conclusions Intensive glucose control reduces the risk for microalbuminuria and macroalbuminuria, but evidence is lacking that intensive glycemic control reduces the risk for significant clinical renal outcomes, such as doubling of the serum creatinine level, ESRD, or death from renal disease during the years of follow-up of the trials.

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