Observation on Renal Outcomes in the Veterans Affairs Diabetes Trial

• Published in: Diabetes care Vol. 34; no. 9; pp. 2090 - 2094
• Main Authors: Agrawal, Lily, Azad, Nasrin, Emanuele, Nicholas V, Bahn, Gideon D, Kaufman, Derrick G, Moritz, Thomas E, Duckworth, William C, Abraira, Carlos
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.09.2011
• Subjects: Aged; Albuminuria - metabolism; Biological and medical sciences; Blood pressure; Blood Pressure - drug effects; blood serum; Body Mass Index; cataract; Comparative analysis; creatinine; Creatinine - urine; Design; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - urine; Diabetes therapy; Diabetes. Impaired glucose tolerance; diastolic blood pressure; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Eye; Female; glomerular filtration rate; Glomerular Filtration Rate - drug effects; glycemic control; Humans; insulin; Insulin - therapeutic use; Kidney diseases; Logistic Models; Male; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; noninsulin-dependent diabetes mellitus; Ophthalmology; Original Research; patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; randomized clinical trials; Statistical analysis; Studies; Surgery; systolic blood pressure; triacylglycerols; Triglycerides; Type 2 diabetes; urine; Variables; veterans; United States; North America; America; Endocrinopathy; Human; Health system; Health insurance; Trial; Prognosis; Nutrition; Diabetes mellitus; Metabolic diseases; Kidney; Urinary system; Observation; Clinical trial; Evolution; Veteran; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc11-0175

OBJECTIVE: The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, controlled trial of 1,791 patients with type 2 diabetes to determine whether intensive glycemic control would reduce cardiovascular events compared with standard control. The effect of intensive glycemic control and selected baseline variables on renal outcomes is reported. RESEARCH DESIGN AND METHODS: Baseline mean age was 60.4 years, mean duration of diabetes was 11.5 years, HbA1c was 9.4%, and blood pressure was 132/76 mmHg. The renal exclusion was serum creatinine >1.6 mg/dL. Renal outcomes were sustained worsening of the urine albumin-to-creatinine ratio (ACR) and sustained worsening by one or more stages in the estimated glomerular filtration rate (eGFR). RESULTS: Intensive glycemic control did not independently reduce ACR progression but was associated with a significant attenuation in the progression of ACR in those who had baseline photocoagulation, cataract surgery, or both. The beneficial effect of intensive glycemic control increased with increasing BMI and with decreasing diastolic blood pressure (DBP). Intensive glycemic control was associated with less worsening of eGFR with increasing baseline ACR and insulin use. Baseline systolic blood pressure, triglycerides, and photocoagulation were associated with worsening of eGFR. CONCLUSIONS: Intensive glycemic control had no significant effect on the progression of renal disease in the whole cohort but was associated with some protection against increasing ACR in those with more advanced microvascular disease, lower baseline DBP, or higher baseline BMI and on worsening of eGFR in those with high baseline ACR.