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Glucose targets for preventing diabetic kidney disease and its progression

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Ruospo, Marinella, Saglimbene, Valeria M, Palmer, Suetonia C, De Cosmo, Salvatore, Pacilli, Antonio, Lamacchia, Olga, Cignarelli, Mauro, Fioretto, Paola +3 more·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd010137.pub2PMC PMC6481869
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Abstract

BACKGROUND: Diabetes is the leading cause of end-stage kidney disease (ESKD) around the world. Blood pressure lowering and glucose control are used to reduce diabetes-associated disability including kidney failure. However there is a lack of an overall evidence summary of the optimal target range for blood glucose control to prevent kidney failure. OBJECTIVES: To evaluate the benefits and harms of intensive (HbA1c < 7% or fasting glucose levels < 120 mg/dL versus standard glycaemic control (HbA1c ≥ 7% or fasting glucose levels ≥ 120 mg/dL for preventing the onset and progression of kidney disease among adults with diabetes. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Specialised Register up to 31 March 2017 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials evaluating glucose-lowering interventions in which people (aged 14 year or older) with type 1 or 2 diabetes with and without kidney disease were randomly allocated to tight glucose control or less stringent blood glucose targets. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for eligibility and risks of bias, extracted data and checked the processes for accuracy. Outcomes were mortality, cardiovascular complications, doubling of serum creatinine (SCr), ESKD and proteinuria. Confidence in the evidence was assessing using GRADE. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS: = 75%, moderate certainty evidence). In absolute terms, tight versus standard glucose control treatment in 1,000 adults would lead to between zero and two people avoiding non-fatal myocardial infarction, while seven adults would avoid experiencing new-onset albuminuria and two would avoid worsening albuminuria. AUTHORS' CONCLUSIONS: This review suggests that people who receive intensive glycaemic control for treatment of diabetes had comparable risks of kidney failure, death and major cardiovascular events as people who received less stringent blood glucose control, while experiencing small clinical benefits on the onset and progression of microalbuminuria and myocardial infarction. The adverse effects of glycaemic management are uncertain. Based on absolute treatment effects, the clinical impact of targeting an HbA1c < 7% or blood glucose < 6.6 mmol/L is unclear and the potential harms of this treatment approach are largely unmeasured.

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  • The updated Cochrane systematic review identified 11 studies that compared a target HbA1c <7.0% to higher HbA1c targets.

    “The updated Cochrane systematic review 250 identi fi ed 11 studies that compared a target HbA1c &lt; 7.0% to higher HbA1c targets (standard glycemic control) (Supplementary Table S11 190,191,232,234,235,240,242 -244,246,251 -253 )”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [250]

    The Included studies section says the review included 14 studies; 11 could be included in its meta-analysis. The claim incorrectly presents the 11 meta-analysed studies as the total identified by the review. The targets table (pp. 58–60) also shows that not every included study specified an HbA1c target below 7% against a higher target. (LLM, conf=0.88)

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Authors
Ruospo, M., Saglimbene, V. M., Palmer, S. C., De Cosmo, S., Pacilli, A., Lamacchia, O., Cignarelli, M., Fioretto, P., Vecchio, M., Craig, J. C., & Strippoli, G. F.
Affiliations
  • Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
  • Diaverum; Medical Scientific Office; Lund Sweden
  • University of Otago (NZ)
  • Scientific Institute CSS; Department of Medicine; Viale Cappuccini San Giovanni Rotondo Italy 71013
  • University of Foggia (IT)
  • University of Padua (IT)
  • Danone (France) (FR)
  • The University of Sydney (AU)
  • Children's Hospital at Westmead (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-06-08
Volume
2017
Issue
6
Pages
CD010137-CD010137
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd010137.pub2
PMC
PMC6481869
OpenAlex
W1912371921
Cited by
111
References
24
Citations by year
2026: 4 · 2025: 11 · 2024: 7 · 2023: 13 · 2022: 15 · 2021: 11 · 2020: 18 · 2019: 8 · 2018: 18 · 2017: 5 · 2014: 1
FWCI
1.79
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
diabetic nephropathy, tight glycemic control, glycemic targets, HbA1c, type 1 diabetes, type 2 diabetes, end-stage renal disease, albuminuria, microalbuminuria, cardiovascular events, myocardial infarction, mortality, proteinuria, serum creatinine doubling
MeSH terms
Albuminuria, Blood Glucose, Cardiovascular Diseases, Cause of Death, Creatinine, Death, Sudden, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Fasting, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemic Agents, Kidney Failure, Chronic, Myocardial Infarction, Time Factors, Randomized Controlled Trials as Topic, Disease Progression, Stroke

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