Improved Survival and Renal Prognosis of Patients With Type 2 Diabetes and Nephropathy With Improved Control of Risk Factors

Andrésdóttir, Gudbjörg; Jensen, Majken L; Carstensen, Bendix; Parving, Hans‐Henrik; Rossing, Kasper; Hansen, Tine W.; Rossing, Peter

doi:10.2337/dc13-2036

Cited by 72 publications

(57 citation statements)

References 36 publications

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“…In this regard, the financial impact of the epidemic spread of the disease becomes more critical and deserves particular consideration. Based on the accelerating increase in diabetes incidence and improved type 2 diabetes prognosis [25], it becomes clear that the health care cost for diabetes management per person will escalate continuously, which represents a current global trend [2].…”

Section: Discussionmentioning

confidence: 99%

10-year Incidence of Diabetes and Associated Risk Factors in Greece: the ATTICA study (2002-2012)

Koloverou¹,

Panagiotakos²,

Pitsavos³

et al. 2014

Rev Diabet Stud

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■ Abstract BACKGROUND:The incidence of diabetes in the general population is increasing world-wide. The increase is attributed to the consumption of saturated fatty acids, obesity, lack of physical activity, genetic predisposition, and other factors, but knowledge about the reasons, biological mechanisms, and late complications is insufficient. It is therefore important to clarify the reasons more exactly through longterm clinical trials to stop the rise of diabetes and its complications. AIM: To evaluate the 10-year incidence of type 2 diabetes in apparently healthy Greek adults. METHODS: In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study. During 2011-2012, the 10-year follow-up was performed. Patients diagnosed with diabetes at baseline (n = 210) and those lost at the 10-year follow-up (n = 1347) were excluded, yielding a final sample of 1485 participants. RESULTS: During the period of investigation, diabetes was diagnosed in 191 cases corresponding to a 12.9% incidence (95%CI: 10.4-15.4), with 13.4% (95%CI: 10.8-16) in men and 12.4% (95%CI: 10.1-14.7) in women. A relative increase was observed in the second half of the 10-year followup when age became significant. Multiple logistic regression analysis revealed that age (OR = 1.14, 95%CI: 1.09-1.19), abnormal waist-to-height ratio (OR = 3.27, 95%CI: 1.07-10.0), fasting blood glucose (OR per 1 mg/dl = 0.05, 95%CI: 1.02-1.08), energy intake (OR per 500 kcal = 1.02, 95%CI: 1.01-1.35), and family history of diabetes (OR = 2.8, 95%CI: 1.30-6.03) were the most significant baseline predictors for diabetes, after adjusting for potential confounders. Waist-to-height ratio showed the best explanatory power of all anthropometric variables. Physical activity exerts an effect on risk factors. Being active was found to eliminate the aggravating effect of diabetes family history and fasting blood glucose. CON-CLUSIONS: The findings confirm the escalating increase of type 2 diabetes incidence in Greece, which is in line with global trends. A lifestyle change in individuals at risk of developing diabetes towards healthier eating and increased physical activity would be an effective and inexpensive means of reducing diabetes.

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Section: Discussionmentioning

confidence: 99%

10-year Incidence of Diabetes and Associated Risk Factors in Greece: the ATTICA study (2002-2012)

Koloverou¹,

Panagiotakos²,

Pitsavos³

et al. 2014

Rev Diabet Stud

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“…This surrogate end point was chosen instead of using hard end points, as the trial is conducted in a normoalbuminuric population. Development of hard renal end points can take up to 20 years12 in such populations, hence, persistent microalbuminuria, which is considered a valid surrogate end point will be a feasible and acceptable outcome for our study 39. The aim to replace albuminuria as a biomarker, by designing a study based on albuminuria as outcome, may appear suboptimal at first glance.…”

Section: Limitations Of This Studymentioning

confidence: 99%

Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy in TYpe 2 diabetic patients with normoalbuminuria (PRIORITY): essential study design and rationale of a randomised clinical multicentre trial

et al. 2016

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Introduction Diabetes mellitus affects 9% of the European population and accounts for 15% of healthcare expenditure, in particular, due to excess costs related to complications. Clinical trials aiming for earlier prevention of diabetic nephropathy by renin angiotensin system blocking treatment in normoalbumuric patients have given mixed results. This might reflect that the large fraction of normoalbuminuric patients are not at risk of progression, thereby reducing power in previous studies. A specific risk classifier based on urinary proteomics (chronic kidney disease (CKD)273) has been shown to identify normoalbuminuric diabetic patients who later progressed to overt kidney disease, and may hold the potential for selection of high-risk patients for early intervention. Combining the ability of CKD273 to identify patients at highest risk of progression with prescription of preventive aldosterone blockade only to this high-risk population will increase power. We aim to confirm performance of CKD273 in a prospective multicentre clinical trial and test the ability of spironolactone to delay progression of early diabetic nephropathy. Methods and analysis Investigator-initiated, prospective multicentre clinical trial, with randomised double-masked placebo-controlled intervention and a prospective observational study. We aim to include 3280 type 2 diabetic participants with normoalbuminuria. The CKD273 classifier will be assessed in all participants. Participants with high-risk pattern are randomised to treatment with spironolactone 25 mg once daily, or placebo, whereas, those with low-risk pattern will be observed without intervention other than standard of care. Treatment or observational period is 3 years. The primary endpoint is development of confirmed microalbuminuria in 2 of 3 first morning voids urine samples. Ethics and dissemination The study will be conducted under International Conference on Harmonisation – Good clinical practice (ICH-GCP) requirements, ethical principles of Declaration of Helsinki and national laws. This first new biomarker-directed intervention trial aiming at primary prevention of diabetic nephropathy may pave the way for personalised medicine approaches in treatment of diabetes complications. Trial registration number NCT02040441; Pre-results.

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“…2,4 T2DM patients with a faster rate of progression will develop the advanced stages of renal dysfunction and "hard" renal end points and cardiovascular outcomes faster. 24,35 Moreover, there is evidence that interventions that slow the rate of decline of renal function in early phases of CKD may be associated with longer-term cardiorenal protection. 23,35 We demonstrate that relatively early in the course of their renal dysfunction, Ao-PWV may identify those at higher risk of progression.…”

Section: Study Limitationsmentioning

confidence: 99%

“…24,35 Moreover, there is evidence that interventions that slow the rate of decline of renal function in early phases of CKD may be associated with longer-term cardiorenal protection. 23,35 We demonstrate that relatively early in the course of their renal dysfunction, Ao-PWV may identify those at higher risk of progression. Further confirmatory studies are required to establish whether Ao-PWV can help risk stratify and identify patients at high risk for progression to advanced renal disease.…”

Section: Study Limitationsmentioning

confidence: 99%

Increased Arterial Stiffness is an Independent Predictor of Renal Function Decline in Patients With Type 2 Diabetes Mellitus Younger Than 60 Years

Fountoulakis

Thakrar

Patel

et al. 2017

JAHA

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BackgroundThe objective of this study was to evaluate whether aortic pulse wave velocity (Ao‐PWV) predicts estimated glomerular filtration rate (eGFR) decline in patients with type 2 diabetes mellitus.Methods and ResultsThis prospective single‐center cohort study investigated 211 type 2 diabetes mellitus patients with eGFR ≥45 mL/min with a baseline mean age of 60.1 years (range, 30–82 years). The mean±SD baseline eGFR was 85±26.1 mL/min. We divided the cohort into 2 groups above (n=117, “older”) and below (n=94, “younger”) the mean age to evaluate whether Ao‐PWV predicted progression of kidney disease differentially in older and younger patients. The primary end point was reaching a final eGFR below the median for the age group and an eGFR fall ≥1 mL/min per year. Median follow‐up was 9 years (range, 3–11 years) and ≈50% of patients in both groups reached the primary end point. In older patients, Ao‐PWV was similar in those who did and did not reach the primary end point. By contrast, younger patients who reached the primary end point had a higher Ao‐PWV at baseline compared with those who did not (10.8 m/s versus 9.5 m/s, respectively; mean difference of 1.36 m/s [95% CI, 0.38–2.33], P=0.007). Ao‐PWV was an independent predictor of the primary end point (incident risk ratio, 1.09; 95% CI, 1.02–1.18) after adjustment for traditional risk factors only in younger patients (P=0.02). A 1m/s increase in Ao‐PWV was associated with a mean fall in eGFR of 2.1 mL/min per year (95% CI, 0.09–4.1) independent of other risk factors in younger patients (P=0.04).ConclusionsAo‐PWV predicts eGFR decline, before the onset of advanced renal dysfunction, and is a potential target for renoprotection in younger patients with type 2 diabetes mellitus.

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Improved Survival and Renal Prognosis of Patients With Type 2 Diabetes and Nephropathy With Improved Control of Risk Factors

Cited by 72 publications

References 36 publications

10-year Incidence of Diabetes and Associated Risk Factors in Greece: the ATTICA study (2002-2012)

10-year Incidence of Diabetes and Associated Risk Factors in Greece: the ATTICA study (2002-2012)

Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy in TYpe 2 diabetic patients with normoalbuminuria (PRIORITY): essential study design and rationale of a randomised clinical multicentre trial

Increased Arterial Stiffness is an Independent Predictor of Renal Function Decline in Patients With Type 2 Diabetes Mellitus Younger Than 60 Years

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