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Aggressive glucose-control strategies reduced onset of albuminuria
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In a retrospective analysis, Patrick J. O’Connor, MD, MA, MPH, of HealthPartners Institute for Education and Research in Minneapolis, and colleagues reported that more aggressive treatment strategies led to a reduction in the onset or progression of albuminuria. Conversely, they discovered a decline in estimated glomerular filtration rate.
Data indicate that 12,085 (23.61%) of 51,179 patients with type 2 diabetes experienced onset or progression of albuminuria after adjustments for covariates, suggesting more aggressive glucose-control strategies played a role in microvascular complications. However, researchers also reported that these aggressive glucose-control strategies (thiazolidinediones or prandial insulin) did not reduce the myocardial infarction rate during a 4-year follow-up period.
Patrick J. O'Connor
“An innovative aspect of this analysis is our use of dynamic [marginal structural models], an analytic approach that permits, under explicit assumptions, proper adjustment for time-dependent confounders on the causal pathway between early exposures and the outcome and enables proper adjustment for selection bias due to informative censoring,” researchers wrote.
They concluded that data were consistent with ACCORD and ADVANCE and demonstrate a need for more long-term studies to confirm these findings.
Disclosure: The researchers report no relevant financial disclosures.
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