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Cited by 15Chronic Kidney Disease and DiabetesDiabetes Treatment and ManagementDiabetes Management and Research

Role of Intensive Glucose Control in Development of Renal End Points in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis

Coca, Steven G., Ismail-Beigi, Faramarz, Haq, Nowreen, Krumholz, Harlan M., Parikh, Chirag R.·2012·Archives of Internal Medicine
DOI 10.1001/archinternmed.2011.2230PMC PMC3688081
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Abstract

Background Aggressive glycemic control has been hypothesized to prevent renal disease in patients with type 2 diabetes mellitus. A systematic review was conducted to summarize the benefits of intensive vs conventional glucose control on kidney-related outcomes for adults with type 2 diabetes. Methods Three databases were systematically searched (January 1, 1950, to December 31, 2010) with no language restrictions to identify randomized trials that compared 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) in patients with type 2 diabetes receiving intensive glucose control vs those receiving conventional glucose control. Results We evaluated 7 trials involving 28 065 adults who were monitored for 2 to 15 years. Compared with conventional control, intensive glucose control reduced the risk for microalbuminuria (risk ratio, 0.86 [95% CI, 0.76-0.96]) and macroalbuminuria (0.74 [0.65-0.85]), but not doubling of the serum creatinine level (1.06 [0.92-1.22]), ESRD (0.69 [0.46-1.05]), or death from renal disease (0.99 [0.55-1.79]). Meta-regression revealed that larger differences in hemoglobin A1c between intensive and conventional therapy at the study level were associated with greater benefit for both microalbuminuria and macroalbuminuria. The pooled cumulative incidence of doubling of the serum creatinine level, ESRD, and death from renal disease was low (<4%, <1.5%, and <0.5%, respectively) compared with the surrogate renal end points of microalbuminuria (23%) and macroalbuminuria (5%). Conclusions Intensive glucose control reduces the risk for microalbuminuria and macroalbuminuria, but evidence is lacking that intensive glycemic control reduces the risk for significant clinical renal outcomes, such as doubling of the serum creatinine level, ESRD, or death from renal disease during the years of follow-up of the trials.

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  • Poor control, defined as a hemoglobin A1c level >9.0%, contributes to complications, including nephropathy, retinopathy, and neuropathy.

    “Poor control, defined as a hemoglobin A1c (HbA1c) level >9.0%, contributes to complications, including nephropathy [1-6], retinopathy [4,7], and neuropathy [4,8].”

    From An Assessment of How Clinicians and Staff Members Use a Diabetes Artificial Intelligence Prediction Tool: Mixed Methods Study (2023) · cites this paper as [6]

    The Introduction reports an association between poor glycemic control and microvascular complications in type 2 diabetes, and the Results > Outcomes section finds that intensive control reduced albuminuria. The paper does not define poor control as HbA1c >9.0% or establish that poor control causes nephropathy; it also finds no demonstrated reduction in clinical renal endpoints. This citation is attached to nephropathy, not to the sentence’s separate retinopathy and neuropathy claims. (LLM, conf=0.88)

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Research works printed but not linked: 12

  1. [1]Kawazu S Tomono S Shimizu M The relationship between early diabetic nephropathy and control of plasma glucose in non-insulin-dependent diabetes mellitus. The effect of glycemic control on the development and progression of diabetic nephropathy in an 8-year follow-up study J Diabetes Complications 1994 8 1 13 17 [8167381] 8167381
  2. [3]The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group N Engl J Med 1993 329 14 977 986 [8366922] 8366922
  3. [4]Ohkubo Y Kishikawa H Araki E Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study Diabetes Res Clin Pract 1995 28 2 103 117 [7587918] 7587918
  4. [5]Levin SR Coburn JW Abraira C Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators Diabetes Care 2000 23 10 1478 1485 [11023140] 11023140
  5. [6]KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease Am J Kidney Dis 2007 49 2 Suppl 2 S12 S154 [17276798] 17276798
  6. [7]Gerstein HC Miller ME Byington RP Effects of intensive glucose lowering in type 2 diabetes N Engl J Med 2008 358 24 2545 2559 [18539917] 18539917 PMC4551392
  7. [9]de Boer IH Rue TC Hall YN Heagerty PJ Weiss NS Himmelfarb J Temporal trends in the prevalence of diabetic kidney disease in the United States JAMA 2011 305 24 2532 2539 [21693741] 21693741 PMC3731378
  8. [12]Higgins JP Thompson SG Deeks JJ Altman DG Measuring inconsistency in meta-analyses Bmj 2003 327 7414 557 560 [12958120] 12958120 PMC192859
  9. [13]Ismail-Beigi F Craven T Banerji MA Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial Lancet 2010 376 9739 419 430 [20594588] 20594588 PMC4123233
  10. [15]Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group Lancet 1998 352 9131 854 865 [9742977] 9742977
  11. [16]Shichiri M Kishikawa H Ohkubo Y Wake N Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients Diabetes Care 2000 23 Suppl 2 B21 B29 [10860187] 10860187
  12. [18]Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study JAMA 2003 290 16 2159 2167 [14570951] 14570951 PMC2622725

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Authors
Coca, S. G., Ismail-Beigi, F., Haq, N., Krumholz, H. M., & Parikh, C. R.
Affiliations
  • Yale University (US)
  • Johns Hopkins University (US)
  • Yale New Haven Hospital (US)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2012-05-28
Volume
172
Issue
10
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2011.2230
PMC
PMC3688081
OpenAlex
W256316318
Cited by
1
References
6
Citations by year
2013: 1
FWCI
0.25
Type
journal article
Language
en
Open access
closed
Locations
Archives of Internal Medicine (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute (U01HL105270)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24DK090203)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
tight glycemic control, type 2 diabetes, diabetic nephropathy, glycemic control, kidney disease progression

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