Via practica 4/2016

Prevention or sloving the progression of diabetic nephropathy. Fact or fiction?

Diabetic nephropathy is the commonest cause of end-stage kidney disease. Diagnosis of diabetic nephropathy based on albuminuria and estimated glomerular filtration rate and subsequent treatment are preconditions for slowing the progression of diabetic nephropathy. In the ADVANCE study authors randomly assigned 11 140 patients with type 2 diabetes to undergo either standard glucose control or intensive glucose control, defined as the use of gliclazide (modified release) plus other drugs as required to achieve a glycated hemoglobin value of 6.5 % or less. A strategy of intensive glucose control yielded a 10 % relative reduction in the combined outcome of major macrovascular and microvascular events, primary as a consequence of a 21 % relative reduction in nephropathy. Intensive glucose control significantly reduced the risk of end-stage renal disease by 65 %, microalbuminuria by 9 % and macroalbuminuria by 30 %. The progression of albuminuria was significantly reduced by 10 % and its regression significantly increased by 15 %. The ADVANCE-ON was a post-trial follow-up study of ADVANCE. Intensive glucose control was associated with a long-term reduction in end-stage kidney disease (-46 %, p = 0.007), without evidence of any increased risk of cardiovascular events or death.

Keywords: diabetes mellitus, ADVANCE, ADVANCE-ON, gliclazide MR, end-stage renal disease, microvascular and macrovascular complications