Intensive glucose control does not prevent renal failure and carries risk of severe hypoglycemia

Aggressive glucose control in patients with type 2 diabetes, while improving surrogate markers of kidney disease, has not been proven to reduce the risk of adverse clinically meaningful renal outcomes, according to a systematic review and meta-analysis of 7 clinical trials.

Key Point: Tight glycemic targets in patients diagnosed with type 2 diabetes don’t necessarily afford protection against clinically significant adverse renal outcomes. Tight glycemic control in this population also carries a risk of severe hypoglycemia and has minimal cardiovascular benefit. Therefore, intensive glycemic control should not be initiated in the midstage of disease progression with the goal of preventing renal failure.

Study results released in India in 2011 indicated that an estimated 62.4 million people in India have diabetes, and up to 77.2 million people have prediabetes. The phase one results of the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) Study included data from 3 states and 1 union territory, representing nearly 18.1% of India's population.

The recently analyzed United States-based trials, which assessed renal outcomes either with either surrogate renal endpoints (ie, albuminuria) or clinical endpoints, compared intensive and conventional glucose control in 28,065 adults who had type 2 diabetes for an average duration of 6.5 years to 12 years upon entry. They were followed for 2 years to 15 years.

Although intensive glucose control reduced the risk of microalbuminuria by 14% and the risk of macroalbuminuria by 26%, it had no significant effect on the rate of a doubling of serum creatinine, development of end-stage renal disease, or death from renal disease.

Given the risk of severe hypoglycemia and its related risks and the minimal cardiovascular benefit associated with tight glucose control, the current finding...

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