Intensive Glycemic Control and End-Stage Renal Disease in Type 2 Diabetes

One case of ESRD was prevented for every 430 intensively treated patients.

In recent randomized trials, intensive glycemic control did not prevent macrovascular events in patients with longstanding type 2 diabetes. In one of those trials (ADVANCE, with 11,000 patients overall; JW Gen Med Jun 6 2008), intensive control prevented macroalbuminuria, a surrogate endpoint for microvascular disease, from developing in some patients. Now, the researchers present information on the most important renal endpoint — progression to end-stage renal disease (ESRD).

After 5 years, mean glycosylated hemoglobin (HbA1c) levels were 7.3% and 6.5% in the standard- and intensive-treatment groups, respectively. ESRD occurred in 20 standard-treatment patients and in 7 intensive-treatment patients. The difference is statistically significant, but about 430 patients underwent intensive glycemic control to prevent 1 case of ESRD. Researchers found no significant differences between groups in incidences of "renal death" or doubling of serum creatinine level.

CITATION(S):

Perkovic V et al. Intensive glucose control improves kidney outcomes in patients with type 2 diabetes. Kidney Int 2013 Mar; 83:517.

Shurraw S and Tonelli M. Intensive glycemic control in type 2 diabetics at high cardiovascular risk: Do the benefits justify the risks? Kidney Int 2013 Mar; 83:346.