Remission of diabetic nephropathy in type 2 diabetic Asian population: role of tight glucose and blood pressure control

Authors

  • Ming-Chia Hsieh,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taichung, Taiwan
    2. Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
    3. Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Yi-Ting Hsieh,

    1. Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
    2. Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
    3. Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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  • Tzu-Jung Cho,

    1. Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
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  • Jung-Fu Chen,

    1. Department of Nutrition Therapy and Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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  • Shi-Dou Lin,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taichung, Taiwan
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  • Hung-Chun Chen,

    1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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  • Shih-Te Tu

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taichung, Taiwan
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Dr Shih-Te Tu, Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan. Tel.: 886 4 7238595 Ext. 1371; fax: 886 4 7238595; e-mail: tzcho27@gmail.com

Abstract

Eur J Clin Invest 2011; 41 (8): 870–878

Abstract

Background  Asian has higher prevalence of diabetic nephropathy (DN) and end-stage renal disease when compared to Caucasian. No study to date has evaluated whether multifactorial intervention was associated with remission of microalbuminuria in type 2 diabetic Asian population. We evaluated the effect of tightly controlling multiple factors on the remission of DN in type 2 diabetic Chinese with microalbuminuria.

Materials and methods  A longitudinal cohort study was collected 587 type 2 diabetic patients with microalbuminuria. Cohort members received intensified treatment to meet the following ADA recommended goals: HbA1c < 7%, systolic blood pressure (SBP) < 130 mmHg, diastolic blood pressure < 80 mmHg, low-density lipoprotein cholesterol < 100 mg dL−1, triglyceride < 150 mg dL−1, high-density lipoprotein cholesterol > 40 mg dL−1 for men and > 50 mg dL−1 for women. Remission of microalbuminuria was defined as shift of albumin–creatinine ratio from mircoalbuminuria to normoalbuminuria.

Results  During the 4·5-year period, 210 (35·8%) patients achieved remission to normoalbuminuria. A significant association was found between the achievement of ADA goals, including HbA1c < 7% [hazard ratio (HR) = 1·345; 95% confidence interval (CI), 1·010–1·792; P = 0·04] and SBP < 130 mmHg (HR, 1·516; 95% CI, 1·100–2·089; P = 0·01) and remission of microalbuminuria. The intensive SBP control (< 120mmHg) was significantly associated with remission of microalbuminuria (HR, 2·076; 95% CI, 1·347–3·198; P < 0·001).

Conclusions  The remission of DN could be achieved under multifactorial intervention. Therapeutic focus on remission by tight glycemic and blood pressure control should be considered in Asian population with diabetes and microalbuminuria.

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