Improving albuminuria reduces the risks for both cardiovascular events and death in patients with diabetic nephropathy who are taking insulin, new study findings suggest.

Of 11,074 patients with type 2 diabetes (T2D) and albuminuria levels of 300 mg/g or greater initiating insulin therapy, 9522 (86%) had persistent or progressive albuminuria after 1 year of intensive glucose control, whereas 1552 (14%) experienced a decrease in their albuminuria to less than 300 mg/g. In the cohort, 682 patients (mean age 62 years) died and 488 experienced a nonfatal myocardial infarction or stroke.

Over 5 years, patients with albuminuria regression had a significant 27% and 31% decrease in their risks for cardiovascular (CV) events and all-cause mortality, respectively, than patients with persistent albuminuria. Iskandar Idris, MBBS, DM, of Royal Derby Hospital Centre in the United Kingdom (UK), and colleagues reported the new data in the American Journal of Nephrology.

“Thus, levels of albuminuria should be considered not only as an important risk marker but also an important therapeutic target for CV and mortality prevention in patients with T2D and should be a key consideration when determining drug choice irrespective of blood pressure and glucose levels,” Dr Idris and the team stated. Common therapeutic strategies that can reduce albuminuria include antihypertensives (namely drugs that inhibit the renin-angiotensin system), tight glucose control, sodium-glucose cotransporter-2 inhibitors, and a low protein diet.

The study involved a large cohort of insulin-treated primary care patients in the Health Improvement Network (THIN) database. This cohort is representative of the UK population, so results are generalizable to similar populations.

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Reference

Anyanwagu U, Donnelly R, Idris I. Albuminuria regression and all-cause mortality among insulin-treated patients with type 2 diabetes: Analysis of a large UK primary care cohort. Am J Nephrol 2019;49:146–155. DOI: 10.1159/000496276