Effects of glycaemic management on diabetic kidney disease

Table 1 Baseline characteristics and renal end points of randomised trials of intensive vs standard glucose control in type 2 diabetes

	UKPDS[29]	ACCORD[30,31]	ADVANCE[7,30]	VADT[32]
Baseline characteristics
No. of subjects	3867	10251	11140	1791
Age (yr)	53	62	66	60
Duration of diabetes (yr)	0	10	8	11.5
History of CV disease (%)	NR	35	32	40
Median HbA1c at baseline (%)	7.0	8.1	7.2	9.4
Duration of follow-up (yr)	10.0	3.5	5.0	5.6
Achieved median HbA1c for I vs S (%) (mmol/mol)	7.0 vs 7.9 (53 vs 63)	6.4 vs 7.5 (46 vs 59)	6.3 vs 7.0 (45 vs 53)	6.9 vs 8.5 (52 vs 69)
Microalbuminuria (%)	11	25	26	N/A
Macroalbuminuria (%)	2	7	4	N/A
Renal outcomes
Microalbuminuria (HR or RR)	0.67a (0.53-0.86)	0.79a (0.69-0.90)	0.91a (0.85-0.98)	0.85 (0.59-1.23)
Macroalbuminuria (HR or RR)	0.66 (0.39-1.10)	0.68a (0.58-0.86)	0.70a (0.57-0.85)	0.56a (0.33-0.96)
Worsening albuminuria (HR or RR)	N/A	N/A	N/A	0.72a (0.53-0.97)
Doubling of creatinine (HR or RR)	0.26a (0.39-1.10)	1.07 (1.01-1.13)	0.83 (0.54-1.27)	1.0 (0.74-1.35)
Decline in eGFR (HR or RR)	N/A	N/A	N/A	0.61 (0.37-1.00)
ESKD (HR or RR)	N/A	0.95 (0.73-1.24)	0.35a (0.15-0.83)	0.63 (0.25-1.6)

^a Significant reduction with intensive glucose control. CV: Cardiovascular; eGFR: Estimated glomerular filtration rate; ESKD: End stage kidney disease; HR: Hazard ratio; RR: Relative risk; N/A: Not available; HbA1c: Glycosylated hemoglobin; I: Intensive glucose control; S: Standard glucose control; UKPDS: United Kingdom Prospective Diabetes Study; ACCORD:Action to Control Cardiovascular Risk in Diabetes; ADVANCE: Action in Diabetes and Vascular Disease Pretrax and Diamicron Modified Release Controlled Evaluation; VADT: Veterans Administration Diabetes Trial.

Table 2 Renal end points in observational post-randomisation trials of intensive glucose control in type 1 and type 2 diabetes

	DCCT/EDIC	ADVANCE ON
Diabetes type	1	2
n	1375	8494
Impaired eGFR (HR or RR)	0.63a (0.10-0.55)	N/A
Impaired eGFR or death (HR or RR)	0.5a (0.18-0.69)	N/A
ESKD (HR or RR)	0.49 (-0.14-0.79)	0.54a (0.34-0.85)
ESKD or renal death (HR or RR)	0.63 (0.10-0.55)	N/A

^aSignificant reduction with intensive glucose control. DCCT/EDIC: Diabetes control and complications trial/epidemiology of diabetes and interventions and complications; ADVANCE: Action in diabetes and vascular disease: Pretrex and diamicron MR controlled evaluation; eGFR: Estimated glomerular filtration rate; ESKD: End stage kidney disease; HR: Hazard ratio; RR: Relative risk; N/A: Not available.

Table 3 Comparison of cardiovascular outcomes and mortality in randomised trials of intensive glucose control in type 2 diabetes participants with and without chronic kidney disease

	ACCORD		ADVANCE
	Total mortality	CV mortality	Total mortality	CV mortality
Overall study results (HR or RR)	1.22a (1.01-1.46)	1.35a (1.04-1.76)	0.93 (0.83-1.06)	0.88 (0.74-1.04)
Non-CKD participants (HR or RR)	1.08 (0.87-1.34)	1.14 (0.82-1.58)	0.74 (0.76-1.15)	0.78 (0.58-1.07)
CKD participants (HR or RR)	1.31a (1.07-1.60)	1.41a (1.05-1.89)	0.91 (0.72-1.14)	0.90 (0.67-1.22)

^aSignificant reduction with intensive glucose control. CV: Cardiovascular; CKD: Chronic kidney disease; ACCORD: Action to control cardiovascular risks in diabetes; ADVANCE: Action in diabetes and vascular disease: Pretrex and diamicron MR controlled evaluation; HR: Hazard ratio; RR: Relative risk.