29 May 2012

Intensive Monitoring and Control of Blood Glucose Levels in Type 2 Diabetes Does Not Lower Risk of Kidney Failure

The first goal of diabetes treatment is to eliminate the symptoms and stabilize blood glucose levels. The ongoing goals are to prevent long-term complications and prolong life. The primary treatment for type 2 diabetes is exercise and diet.
Type 2 diabetes is the most common form of diabetes. 95% of diabetes cases in adults are of this kind. It is associated with obesity, being inactive, and having a family history of diabetes.

Type 2 diabetes means that the body has insulin resistance; the fat, liver, and muscle cells do not respond correctly to insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. If this doesn't happen, the glucose starts to build up to high levels in the blood. This is called hyperglycemia.

If left untreated, hyperglycemia can cause damage to nerves, blood vessels, and other body organs. Chronic hyperglycemia injures the heart, even in patients without a history of heart disease or diabetes. It is also strongly associated with heart attacks and death in subjects with no coronary heart disease or history of heart failure.

As a precaution, people with diabetes constantly monitor their blood sugar levels.

Aggressively controlling glucose levels may not reduce kidney failure in Type 2 diabetes

Yale School of Medicine researchers have found that intensively controlling glucose (glycemic) levels in type-2 diabetes patients may not reduce the risk of kidney failure. The study, which is a review of data from seven clinical trials, is published in the May 28 issue of Archives of Internal Medicine.

To test the hypothesis that aggressive glycemic control can prevent renal disease in patients with type 2 diabetes mellitus, first author Steven G. Coca of Yale and colleagues searched available medical literature and evaluated seven randomized trials involving 28,065 adult patients who were monitored for two to 15 years.

Video: Glucose, Insulin, and Diabetes

The team found that compared with those who had usual treatment, intensively controlling glucose with higher doses of medication did not definitively reduce the risk of impaired kidney function, the need for dialysis, or death from kidney disease.

Coca said many researchers have presumed that such intensive treatment would benefit patients by protecting the kidneys, but these results question whether patients truly are better off with this approach.

"After pooling the results from the follow-up data in the seven studies examined, our analysis shows that intensive glycemic control may improve some things about the kidney that we measure, but did not affect patients' outcomes," said Coca, assistant professor in the section of nephrology in the Department of Internal Medicine at Yale.


Yale University
Archives of Internal Medicine
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