Observation on renal outcomes in the Veterans Affairs Diabetes Trial

Lily Agrawal, Nasrin Azad, Nicholas V. Emanuele, Gideon D. Bahn, Derrick G. Kaufman, Thomas E. Moritz, William C. Duckworth, Carlos Abraira

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

OBJECTIVE - 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. RESEARCH DESIGN AND METHODS - Baseline mean age was 60.4 years, mean duration of diabetes was 11.5 years, HbA 1c 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). RESULTS - 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. CONCLUSIONS - Intensive glycemic control had no significant effect on the progression of renal disease in the whole cohort but was associatedwith 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.

Original languageEnglish
Pages (from-to)2090-2094
Number of pages5
JournalDiabetes Care
Volume34
Issue number9
DOIs
StatePublished - Sep 1 2011

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Veterans
Creatinine
Albumins
Blood Pressure
Kidney
Glomerular Filtration Rate
Light Coagulation
Cataract
Type 2 Diabetes Mellitus
Disease Progression
Triglycerides
Research Design
Randomized Controlled Trials
Urine
Insulin
Serum

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Agrawal, L., Azad, N., Emanuele, N. V., Bahn, G. D., Kaufman, D. G., Moritz, T. E., ... Abraira, C. (2011). Observation on renal outcomes in the Veterans Affairs Diabetes Trial. Diabetes Care, 34(9), 2090-2094. https://doi.org/10.2337/dc11-0175

Observation on renal outcomes in the Veterans Affairs Diabetes Trial. / Agrawal, Lily; Azad, Nasrin; Emanuele, Nicholas V.; Bahn, Gideon D.; Kaufman, Derrick G.; Moritz, Thomas E.; Duckworth, William C.; Abraira, Carlos.

In: Diabetes Care, Vol. 34, No. 9, 01.09.2011, p. 2090-2094.

Research output: Contribution to journalArticle

Agrawal, L, Azad, N, Emanuele, NV, Bahn, GD, Kaufman, DG, Moritz, TE, Duckworth, WC & Abraira, C 2011, 'Observation on renal outcomes in the Veterans Affairs Diabetes Trial', Diabetes Care, vol. 34, no. 9, pp. 2090-2094. https://doi.org/10.2337/dc11-0175
Agrawal L, Azad N, Emanuele NV, Bahn GD, Kaufman DG, Moritz TE et al. Observation on renal outcomes in the Veterans Affairs Diabetes Trial. Diabetes Care. 2011 Sep 1;34(9):2090-2094. https://doi.org/10.2337/dc11-0175
Agrawal, Lily ; Azad, Nasrin ; Emanuele, Nicholas V. ; Bahn, Gideon D. ; Kaufman, Derrick G. ; Moritz, Thomas E. ; Duckworth, William C. ; Abraira, Carlos. / Observation on renal outcomes in the Veterans Affairs Diabetes Trial. In: Diabetes Care. 2011 ; Vol. 34, No. 9. pp. 2090-2094.
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