Diabetic nephropathy can be delayed by tight ADA target control
MedWire News: Achievement of multiple American Diabetes Association (ADA) guideline targets can prevent or delay the onset of diabetic nephropathy in patients with Type 2 diabetes, report researchers.
Diabetic nephropathy is the leading cause of end-stage kidney disease and is common in patients with Type 2 diabetes, particularly those of Asian origin.
Ming-Chia Hsieh (Kaohsiung Medical University Hospital, Taiwan) and colleagues recruited 1290 Type 2 diabetics with normal albumin levels to take part in the study. The patients were aged an average of 62.9 years at baseline and were followed up for 4.5 years.
The participants received intensive treatment to meet ADA goals for glycated hemoglobin (HbA1c; less than 7%), systolic and diastolic blood pressure (less than 130/80 mmHg), low-density lipoprotein (LDL) cholesterol (below 100 mg/dl), triglycerides (below 150 mg/dl), and high-density lipoprotein (HDL) cholesterol (above 40 mg/dl for men and 50 mg/dl for women).
During the study, 211 participants developed new-onset microalbuminuria (albumin-creatinine ratio of 30–299 mg/g), a precursor to diabetic nephropathy.
As reported in the Archives of Internal Medicine, maintenance of treatment goals for HbA1c, systolic blood pressure, and HDL cholesterol was significantly associated with decreased incidence of microalbuminuria following adjustment for potential confounders.
Overall, 8.1%, 71.4%, and 20.5% of the participants attained three, one or two, or none of the above targets, respectively. The fewer the goals obtained the more likely microalbuminuria was to occur.
Diastolic blood pressure, LDL cholesterol, and triglyceride goal maintenance was not significantly associated with the incidence of microalbuminuria, however.
“This study found a strong association between tight simultaneous control of multiple ADA recommended target factors and decreased risk of diabetic nephropathy,” conclude Tu et al.
“This multifactorial intervention should be started in patients with diabetes and normoalbuminuria,” they suggest.
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By Helen Albert