Eugene C. Corbett Jr., MD, MACP
Does intensive glucose control prevent adverse renal outcomes compared with standard control in adults with type 2 diabetes mellitus?
Included studies compared intensive glucose control with standard glucose control (placebo, standard care, or reduced intensity glucose control) in outpatients with stable type 2 diabetes mellitus and reported progression or development of kidney disease as primary or surrogate outcomes. Surrogate renal outcomes were microalbuminuria and macroalbuminuria; clinical renal outcomes were doubling of serum creatinine level, end-stage renal disease (ESRD), and death from renal disease.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Web of Science, and reference lists of identified studies and reviews were searched to December 2010 for randomized controlled trials (RCTs). Investigators were contacted. 7 RCTs (n = 28 065, mean age range 49 to 66 y, 45% to 100% men, median follow-up 2 to 11 y) met inclusion criteria. 5 RCTs described methods for allocation concealment, 6 blinded outcome assessors, and none blinded patients and clinicians.
Meta-analysis showed that intensive glucose control reduced microalbuminuria and macroalbuminuria more than standard control; groups did not differ for doubling of serum creatinine level, ESRD, or death from renal disease (Table).
In patients with type 2 diabetes mellitus, intensive glucose control reduces microalbuminuria and macroalbuminuria, but not clinical renal outcomes, more than standard glucose control.
Intensive vs standard glucose control in adults with type 2 diabetes mellitus*
*Abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, and CI calculated from risk ratios and control event rates in article using a random-effects model.
Corbett Jr. EC. Review: Intensive glucose control reduces surrogate, but not clinical, renal outcomes in type 2 diabetes. Ann Intern Med. ;157:JC5–6. doi: 10.7326/0003-4819-157-10-201211200-02006
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Published: Ann Intern Med. 2012;157(10):JC5-6.
Cardiology, Chronic Kidney Disease, Coronary Risk Factors, Diabetes, Diabetic Nephropathy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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