Glycemic Control Intensity Does Not Influence ESRD, Mortality
End-stage renal disease developed in similar proportions of diabetics regardless of whether they had intensive or standard glycemic control.
Intensive glycemic control is no better than standard control at slowing progression of kidney disease or preventing early death in type 1 or type 2 diabetes patients, Giovanni Strippoli, MD, of Children's Hospital at Westmead in Australia, and colleagues reported in the Annals of Internal Medicine. Intensive therapy targeted a hemoglobin A1c below 7 or fasting glucose below 120 mg/dL.
According to the team's review and meta-analysis of 11 studies including 29,141 patients, the groups had similar rates of progression. End-stage renal disease (ESRD) developed in 1.3% of the intensive-control group compared with 1.6% of the standard-control group. Doubling of serum creatinine occurred in 24% and 25% of the groups, respectively. Mortality rates did not differ significantly. All-cause mortality rates were 9.1% and 8.9%, sudden death 0.9% and 1.2%, and cardiovascular mortality 4.2% and 3.6%, respectively.
Non-fatal cardiovascular risks also did not differ significantly. Myocardial infarction occurred in 3.3% and 4.3% of the intensive- and standard-control groups, respectively. Stroke occurred in 2.8% and 2.7%, respectively. Microalbuminuria developed in 22% and 25% and progressed in 18% and 23% of the groups, respectively.
“This begs the question of whether strict glycemic control for preventing any complications is warranted,” Indranil Dasgupta, MBBS, MD, DM, FRCP, and Ajay Singh, MBBS, FRCP, MBA, commented in an accompanying editorial. They pointed out that these results may not apply to newer type 2 diabetes drugs, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists.
Ruospo M, Saglimbene VM, Palmer SC, et al. Review: In diabetes, intensive and standard glycemic control do not differ for end-stage kidney disease or death. Ann Intern Med. doi:10.7326/ACPJC-2017-167-8-047