Intensive diabetes therapy reduces risk for impaired glomerular filtration rate and ESRD
November - 23 - 2011
A common complication of diabetes is kidney disease, characterized by abnormal glomerular filtration rate (GFR). Impaired GFR in turn leads to cardiovascular disease, end-stage renal disease (ESRD) and mortality. The effect of intensive diabetes therapy on GFR was investigated in two studies, the Diabetes Control and Complications Trial (DCCT, multicenter, randomized), and the Epidemiology of Diabetes Interventions and Complications (EDIC) observational study. In DCCT, 1,441 patients with type 1 diabetes (T1DM) were randomly assigned to either intensive (HbA1c < 6.05%) or conventional diabetes therapy for 6.5 years. In EDIC, 1,375 DCCT participants, representing 96% of the surviving cohort were observed. An impaired GFR was defined as estimated GFR of < 60 mL/min per 1.73 m2 at two consecutive study visits. Both studies combined added up to a median follow-up of 22 years. Impaired GFR was reported in 24 intensive therapy patients and 46 conventional therapy patients. This translated into a 50% reduction in risk associated with intensive therapy. Eight patients in the intensive group and 16 in the conventional group developed ESRD. The results suggest that long-term intensive diabetes therapy reduces the risk for kidney disease and ESRD in patients with T1DM (DCCT/EDIT Research Group. N Engl J Med 2011, Advanced publication).