Renal Outcomes in T2D With Intensive Glycemic Control in Veterans

Kidney disease
Kidney disease
Interim analysis of the follow-up Veterans Affairs Diabetes Trial study shows that intensive glycemic control for a median of 5.6 years may have a modest beneficial effect on delaying the progression of renal disease.

Individuals who receive intensive glycemic control (INT) for an average of 5.6 years may experience an approximately 34% greater chance of maintaining estimated glomerular filtration rate (eGFR) of >60 mL min-1 1.73 m-2 and being placed in a lower kidney disease improving global outcomes (KDIGO) category, according to a study published in Diabetologia. 

Researchers identified 1791 veterans from 20 different veterans’ affairs (VA) medical centers who had type 2 diabetes and a mean hemoglobin (Hb)A1c level of 9.4±2%, and who were participating in the Veterans Affairs Diabetes Trial (VADT; identifier: NCT00032487). Participants were assigned to receive either INT or standard glucose control for an average of 5.6 years. 

Study results found that a significantly higher number of participants receiving INT treatment were able to maintain eGFR >60 mL min-1 (odds ratio 1.34; 95% CI, 1.05-1.1; P =.02). Participants who were at moderate or high risk for chronic kidney disease at the start of the study were noted to have the most evident changes (INT vs standard treatment; relative risk [RR] 1.3; P =.03; and RR 2.3; P =.04, respectively), with a significant number of participants showing enough improvement to be classified in the low KDIGO risk category (RR 6.1; P =.002). 

Researchers concluded that, “after just over 11 years of follow-up, there was a 34% greater odds of maintaining an eGFR of >60 mL min-1 1.73 m-2 and of improving the KDIGO category in individuals with type 2 diabetes who had received INT for a median of 5.6 years.”

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Agrawal L, Azad N, Bahn GD, et al. Long-term follow-up of intensive glycaemic control on renal outcomes in the veterans affairs diabetes trial (VADT) [published online November 3, 2017]. Diabetologia. doi: 10.1007/s00125-017-4473-2