Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus: systematic review and meta-analysis intensive glucose control in type 2 diabetes.
Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus: systematic review and meta-analysis intensive glucose control in type 2 diabetes.
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DOI：
10.1001/archinternmed.2011.2230
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发表时间：
2012-05-28
影响因子：
--
通讯作者：
Parikh CR
中科院分区：
文献类型：
--
作者：
Coca SG;Ismail-Beigi F;Haq N;Krumholz HM;Parikh CR
积极的血糖控制被认为可以预防2型糖尿病患者的肾脏疾病。一项系统综述总结了强化血糖控制与常规血糖控制对成人2型糖尿病患者肾脏相关结局的益处。系统检索了三个数据库（1950年1月至2010年12月），没有语言限制，以确定在接受强化血糖控制与常规血糖控制的2型糖尿病患者中比较替代肾脏终点（微量和大量蛋白尿）和临床肾脏终点（血清肌酐加倍、终末期肾脏疾病[ESRD]和肾脏疾病死亡）的随机试验。7项试验涉及28,065名成年人，随访2至15年。与常规对照组相比，强化葡萄糖控制降低了微量白蛋白尿（风险比[RR]， 0.86 [95% CI, 0.76 - 0.96]）和大量白蛋白尿（RR 0.74 [95% CI, 0.65-0.85]）的风险，但没有使血清肌酐（RR 1.06 [95% CI, 0.92 - 1.22]）、ESRD （RR 0.69 [95% CI, 0.46-1.05]）或肾脏疾病死亡（RR 0.99 [95% CI, 0.55-1.79]）增加一倍。荟萃回归显示，在研究水平上，强化治疗和常规治疗之间HbA1C的较大差异与对微量和大量蛋白尿的更大益处相关。与微量蛋白尿（23%）和大量蛋白尿（5%）的替代肾脏终点相比，肌酐加倍、ESRD和肾脏疾病死亡的累积总发生率较低（分别< 4%、<1.5%和<0.5%）。强化血糖控制降低了微量白蛋白尿和大量白蛋白尿的风险，但缺乏证据表明强化血糖控制降低了重大临床肾脏结局的风险，如肌酐翻倍、ESRD或在试验随访期间因肾脏疾病死亡。
Aggressive glycemic control has been hypothesized to prevent renal disease in type 2 diabetics. A systematic review was conducted to summarize the benefits of intensive versus conventional glucose control on kidney-related outcomes for adults with type 2 diabetes. Three databases were systematically searched (January 1950 to December 2010) with no language restrictions to identify randomized trials that compared surrogate renal endpoints (micro and macroalbuminuria) and clinical renal endpoints (doubling of serum creatinine, End Stage Renal Disease [ESRD] and death from renal disease) in patients with type 2 diabetes receiving intensive glucose control versus receiving conventional glucose control. Seven trials involving 28,065 adults who were followed-up for 2 to 15 years. Compared with conventional control, intensive glucose control reduced the risk for microalbuminuria (risk ratio [RR], 0.86 [95% CI, 0.76 to 0.96]) and macroalbuminuria (RR 0.74 [95% CI, 0.65–0.85]), but not doubling of serum creatinine (RR 1.06 [95% CI, 0.92 to 1.22]), ESRD (RR 0.69 [95% CI, 0.46–1.05]), or death from renal disease (RR 0.99 [95% CI 0.55–1.79]). Meta-regression revealed that larger differences in HbA1C between intensive and conventional therapy at the study level were associated with greater benefit for both micro- and macroalbuminuria. The pooled cumulative incidence of doubling of creatinine, ESRD, and death from renal disease was low (< 4%, <1.5%, and <0.5%, respectively) compared with the surrogate renal endpoints of micro- (23%) and macroalbuminuria (5%). Intensive glucose control reduces the risk for microalbuminuria and macroalbuminuria but evidence is lacking that intensive glycemic control reduces the risk for significant clinical renal outcomes such as doubling of creatinine, ESRD or death from renal disease during the years of follow-up of the trials.
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影响因子：
120.7
作者：
de Boer, Ian H.;Rue, Tessa C.;Hall, Yoshio N.;Heagerty, Patrick J.;Weiss, Noel S.;Himmelfarb, Jonathan
通讯作者：
Himmelfarb, Jonathan
影响因子：
168.9
作者：
Turner, RC;Holman, RR;Ward, JD
通讯作者：
Ward, JD
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
105.7
作者：
Stratton, IM;Adler, AI;Holman, RR
通讯作者：
Holman, RR
DOI：
10.1056/nejmoa1111732
发表时间：
2011-12-22
期刊：
The New England journal of medicine
影响因子：
--
作者：
DCCT/EDIC Research Group;de Boer IH;Sun W;Cleary PA;Lachin JM;Molitch ME;Steffes MW;Zinman B
通讯作者：
Zinman B