02270nas a2200313   4500000000100000008004100001100001700042700001300059700001400072700001800086700001900104700001300123700001100136700001500147700001300162700001400175700001400189700001600203700001600219700001900235700001800254700001500272245008800287250001500375300001100390490000700401520150200408020004601910       2013                            d1 aHeerspink H.1 aLi Qiang1 aCass Alan1 aWoodward Mark1 aZoungas Sophia1 aMarre M.1 aJun M.1 aPoulter N.1 aHamet P.1 aMancia G.1 aCooper M.1 aMogensen C.1 aChalmers J.1 aPerkovic Vlado1 aPatel Anushka1 aMacmahon S00aIntensive glucose control improves kidney outcomes in patients with type 2 diabetes  a2013/01/11  a517-230 v833 a<p>
The effect of intensive glucose control on major kidney outcomes in type 2 diabetes remains unclear. To study this, the ADVANCE trial randomly assigned 11,140 participants to an intensive glucose-lowering strategy (hemoglobin A1c target 6.5% or less) or standard glucose control. Treatment effects on end-stage renal disease ((ESRD), requirement for dialysis or renal transplantation), total kidney events, renal death, doubling of creatinine to above 200 mumol/l, new-onset macroalbuminuria or microalbuminuria, and progression or regression of albuminuria, were then assessed. After a median of 5 years, the mean hemoglobin A1c level was 6.5% in the intensive group, and 7.3% in the standard group. Intensive glucose control significantly reduced the risk of ESRD by 65% (20 compared to 7 events), microalbuminuria by 9% (1298 compared to 1410 patients), and macroalbuminuria by 30% (162 compared to 231 patients). The progression of albuminuria was significantly reduced by 10% and its regression significantly increased by 15%. The results were almost identical in analyses taking account of potential competing risks. The number of participants needed to treat over 5 years to prevent one ESRD event ranged from 410 in the overall study to 41 participants with macroalbuminuria at baseline. Thus, improved glucose control will improve major kidney outcomes in patients with type 2 diabetes.Kidney International advance online publication, 9 January 2013; doi:10.1038/ki.2012.401.
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