Multifactorial intervention has a significant effect on diabetic kidney disease in patients with type 2 diabetes
Open accessAbstract
To evaluate the effect of multifactorial intervention on the onset and progression of diabetic kidney disease in the patients with type 2 diabetes, we analyzed the effects of intensified multifactorial intervention by step-wise intensification of medications and life-style modifications (intensive therapy treatment targets; HbA1c under 6.2%, blood pressure under 120/75 mmHg, low-density lipoprotein cholesterol under 80 mg/dL) comparing with the guideline-based standard care (conventional therapy treatment targets: HbA1c under 6.9%, blood pressure under 130/80 mmHg, low-density lipoprotein cholesterol under 120 mg/dL) on diabetic kidney disease. A total of 2540 eligible patients in the Japan Diabetes Optimal Integrated Treatment for three major risk factors of cardiovascular diseases (J-DOIT3) cohort were randomly assigned to intensive therapy (1269) and conventional therapy (1271) and treated for a median of 8.5 years. The prespecified kidney outcome measure was a composite of progression from normoalbuminuria to microalbuminuria or progression from normoalbuminuria to macroalbuminuria or progression from microalbuminuria to macroalbuminuria, serum creatinine levels elevated by two-fold or more compared to baseline, or kidney failure. Primary analysis was carried out on the intention-to-treat population. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. A total of 438 kidney events occurred (181 in the intensive therapy group and 257 in the conventional therapy group). Intensive therapy was associated with a significant 32% reduction in kidney events compared to conventional therapy and was associated with a change in HbA1c at one year from study initiation. Thus, prespecified analysis shows that intensified multifactorial intervention significantly reduced the onset and progression of diabetic kidney disease compared to currently recommended care.
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Multifactorial intervention in type 2 diabetes reduced the onset and progression of diabetic kidney disease, compared to currently recommended care.
“Multifactorial intervention in T2D reduced the onset and progression of diabetic kidney disease, compared to currently recommended care.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [7]
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- Authors
- Ueki, K., Sasako, T., Okazaki, Y., Miyake, K., Nangaku, M., Ohashi, Y., Noda, M., & Kadowaki, T.
- Affiliations
- National Center for Global Health and Medicine (JP)
- The University of Tokyo (JP)
- Juntendo University (JP)
- Chuo University (JP)
- International University of Health and Welfare Ichikawa Medical Center (JP)
- Toranomon Hospital (JP)
- Corresponding author
- Kadowaki, Takashi
- ORCID
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 99
- Issue
- 1
- Pages
- 256-266
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W3081705370
- Cited by
- 94
- References
- 42
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 18 · 2023: 23 · 2022: 17 · 2021: 8
- FWCI
- 7.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Ministry of Health, Labour and Welfare
- Japan Agency for Medical Research and Development
- 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, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetic nephropathy, type 2 diabetes, multifactorial intervention, tight glycemic control, HbA1c, blood pressure, LDL cholesterol, albuminuria, estimated glomerular filtration rate, renal failure, lifestyle modification
- MeSH terms
- Albuminuria, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Glomerular Filtration Rate, Humans, Japan
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