• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (9)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular System, Other  • Nutritional and Metabolic Disorders  • Lipids and Lipid Disorders  • Cardiovascular System  • Renal Diseases  • Renal Diseases, Other  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

A 4-Year Prospective Analysis

Shih-Te Tu, MD; Shun-Jen Chang, PhD; Jung-Fu Chen, MD; Kai-Jen Tien, MD; Jeng-Yueh Hsiao, MD; Hung-Chun Chen, MD, PhD; Ming-Chia Hsieh, MD, PhD

Arch Intern Med. 2010;170(2):155-161.

Background  No study to date has evaluated whether multifactorial intervention can prevent diabetic nephropathy in patients with type 2 diabetes mellitus and normoalbuminuria. We evaluated the effect of tightly controlling multiple factors recommended by the American Diabetes Association (ADA) on the development and prevention of diabetic nephropathy in Chinese patients with type 2 diabetes mellitus and normoalbuminuria during a 4-year period.

Methods  A longitudinal cohort study enrolled 1290 patients with type 2 diabetes and normoalbuminuria who received intensified treatment to meet the following ADA recommended goals: hemoglobin A_1c (HbA_1c), less than 7%; systolic blood pressure, less than 130 mm Hg; diastolic blood pressure, less than 80 mm Hg; low-density lipoprotein cholesterol, less than 100 mg/dL; triglycerides, less than 150 mg/dL; and high-density lipoprotein cholesterol, greater than 40 mg/dL for men and greater than 50 mg/dL for women.

Results  During the study period, 211 patients (16.4%) developed new-onset microalbuminuria. A significant association was found between the achievement of ADA goals, including HbA_1c level less than 7% (hazard ratio [HR], 0.729; 95% confidence interval [CI], 0.553-0.906; P = .03), systolic blood pressure less than 130 mm Hg (0.645; 0.491-0.848; P = .002), and high-density lipoprotein cholesterol level greater than 50 mg/dL for women and greater than 40 mg/dL for men (0.715; 0.537-0.951; P = .02) and the development of new-onset microalbuminuria.

Conclusions  Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADA-recommended targets. This multifactorial intervention should be started in patients with diabetes and normoalbuminuria.

Author Affiliations: Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua (Dr Tu), Department of Public Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University (Dr Chang), Department of Nutrition Therapy and Internal Medicine, Chang Gung Memorial Hospital (Dr J.-F. Chen), and Divisions of Endocrinology and Metabolism (Drs Hsiao and Hsieh) and Nephrology (Dr H.-C. Chen), Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, and Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Medical Center, Tainan (Dr Tien), Taiwan.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Low Estimated Glomerular Filtration Rate Is a Major Determinant of Low Ankle-Brachial Index and Toe-Brachial Index in Type 2 Diabetes
Sheen et al.
ANGIOLOGY 2012;63:55-61.
ABSTRACT  

Renin-angiotensin-aldosterone system genotypes and haplotypes affect the susceptibility to nephropathy in type 2 diabetes patients
Mtiraoui et al.
Journal of Renin-Angiotensin-Aldosterone System 2011;12:572-580.
ABSTRACT  

Gender differences in the association between HDL cholesterol and the progression of diabetic kidney disease in type 2 diabetic patients
Hanai et al.
Nephrol Dial Transplant 2011;0:gfr417v1-gfr417.
ABSTRACT | FULL TEXT