OBJECTIVE
Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes.
RESEARCH DESIGN AND METHODS
Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%.
RESULTS
Of 5,674 patients, 3,637 (64.1%) received insulin at baseline. Overall, 5,663 patients were included in the analysis for HbA1c; 2,794 (49.3%) had baseline HbA1c <7.5% (58 mmol/mol). Finerenone significantly reduced risk of the kidney composite outcome independent of baseline HbA1c level and insulin use (Pinteraction = 0.41 and 0.56, respectively). Cardiovascular composite outcome incidence was reduced with finerenone irrespective of baseline HbA1c level and insulin use (Pinteraction = 0.70 and 0.33, respectively). Although baseline HbA1c level did not affect kidney event risk, cardiovascular risk increased with higher HbA1c level. UACR reduction was consistent across subgroups. Adverse events were similar between groups regardless of baseline HbA1c level and insulin use; few finerenone-treated patients discontinued treatment because of hyperkalemia.
CONCLUSIONS
Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use.
Objective: The principal aim of this study was to identify factors influencing the severity of peripheral diabetic neuropathy pain (PDNP), a symptom of the common neurological complication of diabetes mellitus, and peripheral diabetic neuropathy.
Methods:A cross-sectional study was performed using two self-administered questionnaires among subjects recruited from outpatient clinics at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia. The Neuropathic Pain-4 tool was used to evaluate the presence of PDNP, and the Short-Form McGill Pain Questionnaire (MPQ) was used to characterize and determine the severity of PDNP. Sociodemographic and clinical data were collected from the patients.Results: The MPQ indicated that most patients reported experiencing mild pain for all sensory pain descriptors other than throbbing and aching (mostly reported to be moderate) and hot-burning (mostly reported to be no pain). The severity of pain was found to be significantly related to the length of time for which the patients had suffered from diabetes in those patients who had been diagnosed over 10 years previously (p=0.04). Indian patients reported a higher severity of pain overall (p=0.04). No significant relationship was found between pain severity and any of the following factors: Type of diabetes (I or II), gender, smoking status, alcohol consumption, obesity, medication taken, or presence of other diseases.
Conclusion:In this study, most patients with PDNP reported the severity of the pain to be "mild." The pain severity may be influenced by a patient's ethnicity and the length of time for which they have suffered from diabetes.
Purpose: To evaluate the quality of life of patients with peripheral diabetic neuropathy pain (PDNP) in QoL, with regard to "freedom to eat", "freedom to drink", "physical health", "family life", and "living
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