Tight rein on glucose no boon in diabetes

Some researchers believe that aggressively controlling glucose levels in type 2 diabetes reduces the risk of impaired kidney function, but a new Yale study found no evidence for this view.

Steven Coca, D.O., M.S., assistant professor of internal medicine, Chirag R. Parikh, M.D., Ph.D., associate professor of medicine, and colleagues analyzed seven clinical trials that together included 28,065 adult patients monitored for up to 15 years. When patients were treated aggressively—with higher drug doses and a lower target blood glucose level than is standard—some markers of kidney function (e.g., protein in the urine) improved over those in patients who received standard treatment. But as reported in the May 28 issue of Archives of Internal Medicine, aggressive treatment did not lower patients’ risk of impaired kidney function, the need for dialysis, or eventual death from kidney disease.

“Intensive glycemic control may improve some things, but did not affect patients’ kidney-related outcomes,” says Coca. “Clinicians who aggressively control glucose to slow kidney disease may now be more cautious, and academic and industry researchers may question whether protein in the urine is a reliable surrogate measure in trials of new drugs for type 2 diabetes.”