Diabetes accounts for almost 50% of cases of end-stage renal disease (ESRD) in high-income countries (1). Although the impact of intensive glycemic control on macrovascular complications is relatively modest, evidence suggests that tight glucose control may reduce kidney disease progression. The role of glucose control in preventing chronic kidney disease and ESRD continues to be of significant interest. The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, multicenter study in 1,791 veterans with poorly controlled type 2 diabetes, primarily to determine the impact of 5.6 years of tight versus standard glycemic control on cardiovascular events; secondary outcomes included microvascular disease. After the 5.6-year interventional period, the cohort was observationally followed for an additional 10 years (median follow-up was 15 years, ending in 2017) and provided a unique view of the impact of glycemic control on important clinical outcomes. As previously reported, baseline demographics, clinical characteristics, statin and blood pressure medicine use, and mean HbA1c (9.4 ± 2% [79.2 mmol/mol]) were balanced between the two groups (2). Participants received either intensive (INT) or standard (STD) glucose control for a median of 5.6 years. The median HbA1c achieved was 1.5% lower in INT versus STD during the intervention phase (6.9% vs. 8.4% [52 vs. 68 mmol/mol]). Subsequent diabetes care was provided by their primary health care team, and participants were followed using the Department of Veterans …
Intensive Glycemic Control Improves Long-term Renal Outcomes in Type 2 Diabetes in the Veterans Affairs Diabetes Trial (VADT) | Litlas
