Observation on renal outcomes in the Veterans Affairs Diabetes Trial.
Observation on renal outcomes in the Veterans Affairs Diabetes Trial.
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DOI：
10.2337/dc11-0175
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发表时间：
2011-09
期刊：
影响因子：
16.2
通讯作者：
Veterans Affairs Diabetes Trial (VADT) Study Group
中科院分区：
文献类型：
--
作者：
Agrawal L;Azad N;Emanuele NV;Bahn GD;Kaufman DG;Moritz TE;Duckworth WC;Abraira C;Veterans Affairs Diabetes Trial (VADT) Study Group
退伍军人事务部糖尿病试验（VADT）是一项随机、前瞻性、对照试验，共有1,791例2型糖尿病患者参加，旨在确定与标准对照相比，强化血糖控制是否会减少心血管事件。报告了强化血糖控制和选定的基线变量对肾脏结局的影响。基线平均年龄为60.4岁，糖尿病平均病程为11.5年，HbA 1c为9.4%，血压为132/76 mmHg。肾排除是血清肌酐>1.6 mg/dL。肾脏结局为尿白蛋白/肌酐比值（ACR）持续恶化和估计肾小球滤过率（eGFR）持续恶化一个或多个阶段。强化血糖控制并不能独立地减少ACR进展，但与基线光凝、白内障手术或两者兼有的患者的ACR进展显著减弱相关。强化血糖控制的有益效果随着BMI的增加和舒张压（DBP）的降低而增加。强化血糖控制与eGFR恶化较少相关，基线ACR和胰岛素使用增加。基线收缩压、甘油三酯和光凝与eGFR恶化相关。在整个队列中，强化血糖控制对肾脏疾病的进展没有显著影响，但在更晚期微血管疾病、基线DBP较低或基线BMI较高的患者中，强化血糖控制对ACR增加有一定的保护作用，在基线ACR较高的患者中，强化血糖控制对eGFR恶化有一定的保护作用。
The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, controlled trial of 1,791 patients with type 2 diabetes to determine whether intensive glycemic control would reduce cardiovascular events compared with standard control. The effect of intensive glycemic control and selected baseline variables on renal outcomes is reported. Baseline mean age was 60.4 years, mean duration of diabetes was 11.5 years, HbA1c was 9.4%, and blood pressure was 132/76 mmHg. The renal exclusion was serum creatinine >1.6 mg/dL. Renal outcomes were sustained worsening of the urine albumin-to-creatinine ratio (ACR) and sustained worsening by one or more stages in the estimated glomerular filtration rate (eGFR). Intensive glycemic control did not independently reduce ACR progression but was associated with a significant attenuation in the progression of ACR in those who had baseline photocoagulation, cataract surgery, or both. The beneficial effect of intensive glycemic control increased with increasing BMI and with decreasing diastolic blood pressure (DBP). Intensive glycemic control was associated with less worsening of eGFR with increasing baseline ACR and insulin use. Baseline systolic blood pressure, triglycerides, and photocoagulation were associated with worsening of eGFR. Intensive glycemic control had no significant effect on the progression of renal disease in the whole cohort but was associated with some protection against increasing ACR in those with more advanced microvascular disease, lower baseline DBP, or higher baseline BMI and on worsening of eGFR in those with high baseline ACR.
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影响因子：
168.9
作者：
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