Intensive therapy benefits attenuated by adjusting for glycated hemoglobin, albumin excretion
MONDAY, Nov. 14 (HealthDay News) -- Long-term intensive diabetes therapy reduces the risk of impaired glomerular filtration rate (GFR), according to a study published online Nov. 12 in the New England Journal of Medicine to coincide with presentation at the American Society of Nephrology's annual meeting, Kidney Week 2011, held from Nov. 8 to 13 in Philadelphia.
Ian H. deBoer, M.D., from the University of Washington in Seattle, and colleagues investigated the long-term effects of intensive diabetes therapy on GFR impairment risk. Participants included 1,441 individuals with type 1 diabetes from the Diabetes Control and Complications Trial (DCCT) who underwent 6.5 years of intensive or conventional therapy; and 1,375 of these participants who subsequently continued to the observational Epidemiology of Diabetes Interventions and Complications (EDIC) study. Participants were followed up for a median of 22 years in the combined studies. Incident GFR of less than 60 ml/minute per 1.73 m² of body-surface area at two consecutive study visits was considered impaired GFR.
The investigators identified impaired GFR in 24 and 46 patients after intensive and conventional therapy, respectively (risk reduction with intensive therapy, 50 percent), of whom eight and 16 patients, respectively, developed end-stage renal disease. Intensive therapy was linked to a reduction in the mean estimated GFR of 1.7 ml/minute/1.73 m² in the DCCT study and to a slower rate of reduction in the GFR and an increase in the mean estimated GFR of 2.5 ml/minute/1.73 m² in the EDIC study, compared with conventional therapy. Adjustment for glycated hemoglobin levels or albumin excretion rates fully attenuated the intensive therapy benefits on the risk of GFR impairment.
"The long-term risk of an impaired GFR was significantly lower among persons treated early in the course of type 1 diabetes with intensive diabetes therapy," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry. Discounted or free supplies or equipment were provided for the study by the pharmaceutical, medical technology, and medical device industries.
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