Tuesday, May 29, 2012
On Second Thought.... Intensive Glucose Control Won't Necessarily Prevent Renal Impairment
Patients with type 2 diabetes won't necessarily escape renal complications with intensive glucose control, according to a meta-analysis of seven trials, published in the Archives of Internal Medicine.
Researchers examined renal outcomes — both surrogate (albuminuria) and clinical (creatinine doubling, end-stage renal disease, and death from renal disease) — in some 28,000 patients randomized to intensive or standard glycemic control. They found that although albuminuria was less likely with intensive control, the rate of clinical renal outcomes was roughly the same in the two groups.
One commentator argues that the studies included in the analysis were of too brief duration to provide definitive results. Other commentators point out that intensive control with multidrug regimens carries its own potential harms, including possibly higher cardiovascular risks, and that there are 50 CV deaths for every kidney-related death in patients with type 2 diabetes.