Intensive Glucose Control Helps Surrogate Renal End Points

Meta-analysis shows that intensive control does not improve clinical renal end points in diabetes

THURSDAY, May 31 (HealthDay News) -- Intensive glucose therapy significantly reduces microalbuminuria and macroalbuminuria in adults with type 2 diabetes, but does not improve clinical renal outcomes, according to a study published in the May 28 issue of the Archives of Internal Medicine.

To compare kidney-related outcomes associated with glucose control, Steven G. Coca, D.O., from the Yale University School of Medicine in New Haven, Conn., and colleagues conducted a systematic literature review and meta-analysis of randomized trials of patients with type 2 diabetes receiving intensive versus conventional glucose control. 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) were assessed in seven trials involving 28,065 adults.

The researchers found that intensive glucose control correlated with a significantly reduced risk for microalbuminuria (risk ratio [RR], 0.86; 95 percent confidence interval [CI], 0.76 to 0.96) and macroalbuminuria (RR, 0.74; 95 percent CI, 0.65 to 0.85), compared to conventional control, but did not result in a significantly reduced risk of doubling of the serum creatinine level (RR, 1.06; 95 percent CI, 0.92 to 1.22), ESRD (RR, 0.69; 95 percent CI, 0.46 to 1.05), or death from renal disease (RR, 0.99; 95 percent CI, 0.55 to 1.79). Larger between-group differences in glycated hemoglobin at the study level correlated with greater benefit for microalbuminuria and macroalbuminuria. The pooled cumulative incidence of clinical end points (doubling of the serum creatinine level, <4 percent; ESRD, <1.5 percent; and death from renal disease, <0.5 percent) was low compared with the surrogate renal end points of microalbuminuria (23 percent) and macroalbuminuria (5 percent).

"Intensive glycemic control reduces albuminuria, but evidence is lacking that it prevents clinically meaningful renal outcomes," the authors write.

One author disclosed financial ties to United Healthcare and Medtronic.

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