Intensive glycemic control improves long-term renal outcomes in type 2 diabetes in the Veterans Affairs Diabetes Trial (VADT)
Open accessAbstract
Diabetes accounts for almost 50% of cases of end-stage renal disease (ESRD) in high-income countries (1). Although the impact of intensive glycemic control on macrovascular complications is relatively modest, evidence suggests that tight glucose control may reduce kidney disease progression. The role of glucose control in preventing chronic kidney disease and ESRD continues to be of significant interest. The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, multicenter study in 1,791 veterans with poorly controlled type 2 diabetes, primarily to determine the impact of 5.6 years of tight versus standard glycemic control on cardiovascular events; secondary outcomes included microvascular disease. After the 5.6-year interventional period, the cohort was observationally followed for an additional 10 years (median follow-up was 15 years, ending in 2017) and provided a unique view of the impact of glycemic control on important clinical outcomes. As previously reported, baseline demographics, clinical characteristics, statin and blood pressure medicine use, and mean HbA1c (9.4 ± 2% [79.2 mmol/mol]) were balanced between the two groups (2). Participants received either intensive (INT) or standard (STD) glucose control for a median of 5.6 years. The median HbA1c achieved was 1.5% lower in INT versus STD during the intervention phase (6.9% vs. 8.4% [52 vs. 68 mmol/mol]). Subsequent diabetes care was provided by their primary health care team, and participants were followed using the Department of Veterans …
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The ADVANCE and VADT trials found modest reduction in nephropathy with intensive glycemic management; ACCORD was stopped after a median of 3.5 years due to higher mortality in the intervention arm.
“The ADVANCE and VADT trials found modest reduction in nephropathy with intensive glycemic management; ACCORD was stopped after a median of 3.5 years due to higher mortality in the intervention arm (51-55).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [55]
The VADT results section (page not provided) reports a 19% reduction in a composite renal outcome with intensive glycemic control at 15 years, supporting the VADT portion of the sentence. The paper does not report the ADVANCE nephropathy finding or the claim that ACCORD was stopped after a median of 3.5 years because of higher mortality. (LLM, conf=0.88)
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References 5 · Cited by 20
- Authors
- Agrawal, L., Azad, N., Bahn, G. D., Reaven, P. D., Hayward, R. A., Reda, D. J., Emanuele, N. V., VADT Study Group, Abraira, C., Duckworth, W. C., Hayden, C. T., Paul, C., Arca, D., Zolotor, R. M., Williams, L., Hayden, C. T., Collier, S. L., Ahmed, N., Boyd, A., Reda, D., Moritz, T., Anderson, R., Vitek, M. E., Paine, T., Thottapurathu, L., Luo, P., Bukowski, K., Motyka, D., Barillas, V., Brown, R., Christine, B., Anfinsen, L., Biondic, M., Havlicek, R., Kubal, J., McAuliffe, M., McCarren, M., Rachelle, M., Rose, L., Sacks, J., Sindowski, T., Thomas, J., Zahora, C., Sather, M. R., Day, J., Haroldson, J., Abraira, C., Duckworth, W., Davis, S. N., Emanuele, N., Goldman, S., Hayward, R., Marks, J., Moritz, T., Reaven, P., Reda, D., Warren, S., Zieve, F., Wendell, W., Haroldson, J., Harper, P., Henderson, W. G., Henry, R. R., Kirkman, M. S., McCarren, M., Sacks, J., Gavin, J., Chew, E., Howard, B., Karrison, T., Pacold, I. V., Seigel, D., Vinicor, F., Massie, B., Goldman, S., Rapcsak, S., Sethi, G., Sharon, M., Thai, H., Zadina, K., Christensen, J., Morrison, D., Spooner, P., Westerband, A., Materson, B., Brinton, E., Klein, R., Colwell, J. A., Schaefer, E. J., Gass, C. S., Ehrmann, D. A., Rue, P., Schaefer, E. J., McNamara, J. R., Brophy, M., Humphries, D., Govan, D., McDonnell, L., Carlton, L., Weng, Y., Hayward, R. A., Krein, S., Goldman, S., Zadina, K., Soule, J., Caulder, S., Pittman, C., Alston, O., Mayfield, R. K., Moffitt, G., Sagel, J., Sanacor, F., Ganaway, E., Marks, J., Okur, L., Jones, L., Florez, H., Pfeifer, D., Samos, L., Taylor, A. L., Zimering, M. B., Sama, A., Rosenberg, F., Garcia, H., Ertel, N., Pogach, L., Shin, J. J., Caldarella, F., Carseli, C., Shah, M., Ginier, P., Arakel, G., Fu, Y., Tayloe, D., Allen, J. E., Fox, E., Hensley, P. G., Emanuele, N., Kahsen, K., Linnerud, P., Agrawal, L., Azad, N., Marcelli, M., Cunningham, G. R., Nichols, N. M., Cordero, E., Hijazi, R., Roman, F., Datta, P., Touza, M. G., Lteif, A., Moore, K. L., Lazar-Robinson, C., Gupta, S., Kirkman, M. S., Mendez, M., Haider, Z., Risley, L., Karounos, D., Barber, L., Hibbard, J., Anderson, J. W., Reynolds, L. R., Carlsen, J., Collins, R. W., Kashyap, M. L., Matheus, B., Rahbarnia, T., Vo, A. N., Downey, N., Fox, L., Gonzales, R. M., Meyers, C. D., Tavintharan, S., Nuttall, F. Q., Cupersmith, L., Dardick, K., Kollman, L., Georgopoulos, A., Niewoehner, C., Davis, N. S. N., Harper, P., Davis, D., Devin, J., Marney, A., Passyn-Dunn, J., Perkins, J., Stafford, J., Balch, L., Harris, P., Anderson, R. J., Dunning, D., Ludwig, S., Vogel, M., DeSouza, C., Ecklund, R., Doran, S., Korolchuk, C., McElmeel, M., Wagstaff, S., Reaven, P., Solie, B., Matchette, J., Meyer, C., Vela, S., Aslam, N., Brinton, E., Clark, J., Domb, A., McDonald, L., Shurtz, L., Rao, R. H., Beattie, J. N., Franko, C., DeRubertis, F. R., Kelly, D., Maser, M., Paul, J., Zieve, F., Clark, S. J., Grimsdale, A., Fredrickson, S., Levy, J., Schroeder, D., Iranmanesh, A., Dunn, B., Arsura, D., Kovesdy, C., Hanna, S., Iranmanesh, A., Florow, C., Remandaban, F., Smith, E., Henry, R. R., Keller, M., Aroda, V., Choe, C., Edelman, S., Gasper, A., MaFong, D., Mudaliar, S., Oh, D., Bandukwala, R., Chang, A., Chaudhary, S., Chinnapongse, S., Christiansen, L., Chu, N., Kim, D., Lupo, M., Chandran, M., Plodkowski, R., Sathyaprakash, R., Wilson, J., Yu, J., Macaraeg, G., Townes, S., DeFronzo, R., Johnson, L., Cusi, K., Tripathy, D., Bajaj, M., Blodgett, J., Kayshup, S., Vasquez, M. H., Walz, B., Weaver, T., Benabe, J., Mercado, Z., Padilla, B., Serrano-Rodriguez, J., Rosado, C., Mejias, E., Tejera, T., Geldrez, C., Gonzalez-Melendez, E., Natal, M., Jimenez, M. R., Shah, J. H., Wendel, W. S., Scott, L., Gurnsey, L. A., Kwiecinski, F. A., Boyden, T., Goldschmid, M. G., & Easton, V.
- Affiliations
- Edward Hines, Jr. VA Hospital (US)
- Carl T. Hayden VA Medical Center, Phoenix, AZ
- Cooperative Studies Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL
- Endocrinology Section, Medical Service, Edward Hines Jr. VA Hospital, Hines, IL
- ORCID
- Boyd, Angela
- Luo, Ping
- Christine, Barbara
- Davis, Stephen N.
- Gavin, James
- Chew, Emily
- Howard, Barbara
- Rapcsak, Steven
- Klein, Ronald
- Gass, Carlton S.
- Ehrmann, David A.
- McNamara, Judith R.
- Brophy, Mary
- Krein, Sarah
- Florez, Hermes
- Zimering, Mark B.
- Pogach, Leonard
- Shin, John J.
- Marcelli, Marco
- Cunningham, Glenn R.
- Datta, Paromita
- Gupta, Sanjay
- Anderson, James W.
- Reynolds, L. Raymond
- Kashyap, Moti L.
- Vo, Anthony N.
- Devin, Jessica
- Stafford, John
- DeSouza, Cyrus
- Meyer, Christian
- Rao, R. Harsha
- Clark, Susan J.
- Iranmanesh, Ali
- Kovesdy, Csaba
- Aroda, Vanita
- Edelman, Steven
- Mudaliar, Sunder
- Kim, Dennis
- Lupo, Mark
- Chandran, Manju
- DeFronzo, Ralph
- Johnson, Lisa
- Cusi, Ken
- Tripathy, Devjit
- Boyden, Thomas
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-09-23
- Volume
- 42
- Issue
- 11
- Pages
- e181-e182
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC6804611
- OpenAlex
- W2974996295
- Cited by
- 20
- References
- 5
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 2
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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, chronic kidney disease progression, end-stage renal disease, veterans, HbA1c, long-term renal outcomes, microvascular complications
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