Intensive Glucose Control in Diabetes Reduces Kidney and Eye Events

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Four major clinical trials (ACCORD, ADVANCE, UKPDS, and VADT) were included in the meta-analysis.
Four major clinical trials (ACCORD, ADVANCE, UKPDS, and VADT) were included in the meta-analysis.

In a recent meta-analysis, researchers from numerous international and US universities found that more intensive glucose control was associated with a reduced relative risk for kidney and eye events in patients with type 2 diabetes. Their findings were published in the Lancet Diabetes & Endocrinology.1

Diabetes results in severe complications related to impaired kidney function and eye and nerve damage.2 Improved glucose control is a standard goal in diabetes management, and the number of available treatment strategies has increased. However, the effects of various levels of glucose control for patients with type 2 diabetes are unclear because of inconclusive findings or the study limitations of previous research.

In an earlier meta-analysis of 27,049 patients with type 2 diabetes from 4 large randomized trials, the current authors demonstrated a reduction in major cardiovascular events with more vs less intensive glucose control (hazard ratio [HR], 0.91; 95% CI, 0.84-0.99).3

In the present investigation, researchers conducted a second analysis of the same patient data to assess the effects of more vs intensive glucose control on microvascular events involving the kidneys, nerves, and eyes. Each type of event was defined as a composite of various relevant negative outcomes.

During the median follow-up period of 5.0 years, more intensive glucose control led to an absolute difference of −0.90% (95% CI, −1.22% to −0.58%) in mean hemoglobin A1c. There were 1626 kidney events, 795 eye events, and 7598 nerve events.

The relative risk for kidney events decreased by 20% (HR, 0.80; 95% CI, 0.72-0.88; P <.0001) with more intensive control; this was mainly driven by "reduced risks of development of overt nephropathy (macroalbuminuria) but also nonsignificant reduction in risks of end-stage kidney disease and renal death," the researchers explained.

The relative risk for eye events decreased by 13% (HR, 0.87; 95% CI, 0.76-1.00; P =.04), which was mainly driven by decreased risk for retinopathy progression. There was no significant change in risk for nerve events (HR, 0.98; 95% CI, 0.87-1.09; P =.68).

These results underscore the importance of glucose control in preventing some of the long-term microvascular complications of diabetes.

The researchers report financial relationships with several pharmaceutical companies, including Amgen, AstraZeneca/BMS, Janssen, Takeda, Merck Sharp & Dohme, Bayer, and Novo Nordisk, among others.

References

  1. Zoungas S, Arima H, Gerstein HC, et al; Collaborators on Trials of Lowering Glucose (CONTROL) group. Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5(6):431-437. doi:10.1016/S2213-8587(17)30104-3
  2. Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med. 2014;370:1514-1523. doi:10.1056/NEJMoa1310799
  3. Turnbull FM, Abraira C, Anderson RJ, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52(11):2288-2298. doi:10.1007/s00125-009-1470-0
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