Effect of intensive diabetes treatment on albuminuria in type 1 diabetes: long-term follow-up of the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study.
Effect of intensive diabetes treatment on albuminuria in type 1 diabetes: long-term follow-up of the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study.
复制标题
DOI：
10.1016/s2213-8587(14)70155-x
复制
发表时间：
2014-10
影响因子：
44.5
通讯作者：
Zinman, Bernard
中科院分区：
文献类型：
--
作者：
de Boer, Ian H.;Sun, Wanjie;Gao, Xiaoyu;Cleary, Patricia A.;Lachin, John M.;Molitch, Mark E.;Steff, Michael W.;Zinman, Bernard
1型糖尿病患者发生蛋白尿的危险性有多大？对肾脏疾病长期临床病程的影响仍有待确定。我们的目的是比较强化治疗与常规治疗对蛋白尿的长期影响。在糖尿病控制和并发症试验（DCCT）的长期随访研究中，我们评估了试验完成后18年内强化糖尿病治疗对蛋白尿的影响。在DCCT（1983-1993）期间，1441例1型糖尿病患者被随机分配接受强化治疗（目的是使血糖水平尽可能安全地接近非糖尿病范围）或常规治疗（目的是预防高血糖和低血糖症状）。在DCCT结束时，所有参与者都接受了强化治疗的指导，并邀请所有参与者参加糖尿病干预和并发症（EDIC）研究的观察性流行病学。EDIC研究期间，DCCT期间治疗分配不同的两组患者的平均HbA 1c相似。在EDIC研究期间，每隔一年测量一次白蛋白排泄率。微量白蛋白尿定义为连续两次研究访视时白蛋白排泄率≥ 30 mg/24 h，大量白蛋白尿定义为白蛋白排泄率≥ 300 mg/天。在DCCT和EDIC研究中，我们根据每年的血清肌酐测量值估计肾小球滤过率。DCCT在ClinicalTrials.gov注册，编号NCT 00360815，EDIC研究注册，编号NCT 00360893。在EDIC的第1-18年期间，我们注意到191例新的微量白蛋白尿病例（DCCT期间接受强化治疗组71例，DCCT期间接受常规治疗组120例;风险降低45%，95%CI 26-59）和117例新的大量白蛋白尿病例（31例强化治疗，86例常规治疗; 61%，41-74）。EDIC第17-18年时，DCCT期间接受强化治疗的受试者中白蛋白排泄率≥ 30 mg/24 h的患病率为18.4%，而接受常规治疗的受试者为24.9%（p= 0.02）。在EDIC的1-18年期间，我们记录了84例持续估计肾小球滤过率低于60 mL/min/1·73 m2的病例（31例强化，53例常规;风险降低44%，95%CI 12-64）。在1型糖尿病患者中，强化糖尿病治疗可产生持久的肾脏益处，在应用后至少持续18年。最终，这些益处将导致需要肾脏替代治疗的患者减少。国家糖尿病、消化和肾脏疾病研究所。
Intensive diabetes treatment reduces the risk of developing albuminuria in individuals with type 1 diabetes. Effects on the long-term clinical course of kidney disease remain to be defined. We aimed to compare the long-term effects of intensive versus conventional treatment on incident albuminuria. For this long-term follow-up study of the Diabetes Control and Complications Trial (DCCT) we assessed the effect of intensive diabetes treatment on albuminuria during 18 years after the completion of the trial. During the DCCT (1983–1993), 1441 participants with type 1 diabetes were randomly assigned to receive either intensive treatment (with the goal of achieving levels of glycaemia as close to the non-diabetic range as safely possible) or conventional treatment (aimed at prevention of symptoms of hyperglycaemia and hypoglycaemia). At the end of the DCCT, all participants were instructed in intensive treatment, and all participants were invited to join the observational Epidemiology of Diabetes Interventions and Complications (EDIC) study. Mean HbA1c during the EDIC study was similar in the two groups of patients who differed in their treatment assignment during the DCCT. Albumin excretion rate was measured every other year during the EDIC study. Microalbuminuria was defined as an albumin excretion rate of 30 mg per 24 h or higher on two consecutive study visits and macroalbuminuria as an albumin excretion rate of 300 mg per day or higher. We estimated glomerular filtration rate from annual serum creatinine measurements throughout DCCT and the EDIC study. The DCCT is registered with ClinicalTrials.gov, number NCT00360815, and the EDIC study, with number NCT00360893. During years 1–18 of EDIC, we noted 191 new cases of microalbuminuria (71 in the group receiving intensive treatment during DCCT and 120 in the group receiving conventional treatment during DCCT; risk reduction 45%, 95% CI 26–59) and 117 new cases of macroalbuminuria (31 intensive, 86 conventional; 61%, 41–74). At year 17–18 of EDIC, the prevalence of albumin excretion rate of 30 mg per 24 h or higher was 18·4% in participants assigned to intensive treatment during the DCCT, compared with 24·9% in participants assigned to conventional treatment (p=0·02). During years 1–18 of EDIC, we recorded 84 cases of sustained estimated glomerular filtration rate lower than 60 mL/min per 1·73m2 (31 intensive, 53 conventional; risk reduction 44%, 95% CI 12–64). In individuals with type 1 diabetes, intensive diabetes treatment yields durable renal benefits that persist for at least 18 years after its application. Ultimately, such benefits should result in fewer patients requiring renal replacement therapy. National Institute of Diabetes and Digestive and Kidney Disease.