@article{dbaa4f8b5d394ea886e2e018d0e6e2ad,
title = "Long-term follow-up of intensive glycaemic control on renal outcomes in the Veterans Affairs Diabetes Trial (VADT)",
abstract = "Aims/hypothesis: We conducted an analysis of data collected during the Veterans Affairs Diabetes Trial (VADT) and the follow-up study (VADT-F) to determine whether intensive (INT) compared with standard (STD) glycaemic control during the VADT resulted in better long-term kidney outcomes. Methods: VADT randomly assigned 1791 veterans from 20 Veterans Affairs (VA) medical centres who had type 2 diabetes mellitus and a mean HbA1c of 9.4 ± 2% (79.2 mmol/mol) at baseline to receive either INT or STD glucose control for a median of 5.6 years (randomisation December 2000 to May 2003; intervention ending in May 2008). After the trial, participants received routine care through their own physicians within the VA. This is an interim analysis of the VADT-F (June 2008 to December 2013). We collected data using VA and National databases and report renal outcomes based on serum creatinine, eGFR and urine albumin to creatinine ratio (ACR) in 1033 people who provided informed consent to participate in the VADT-F. Results: By the end of the VADT-F, significantly more people who received INT treatment during the VADT maintained an eGFR >60 ml min−1 1.73 m−2 (OR 1.34 [95% CI 1.05, 1.71], p = 0.02). This benefit was most evident in those who were classified as at moderate risk (INT vs STD, RR 1.3, p = 0.03) or high risk (RR 2.3, p = 0.04) of chronic kidney disease on the Kidney Disease Improving Global Outcomes (KDIGO-CKD) at the beginning of VADT. At the end of VADT-F, significantly more people from the INT group improved to a low KDIGO risk category (RR 6.1, p = 0.002). During the VADT-F there were no significant differences between INT and STD for average HbA1c, blood pressure or lipid levels. Conclusions/interpretation: After just over 11 years of follow-up, there was a 34% greater odds of maintaining an eGFR of >60 ml min−1 1.73 m−2 and of improving the KDIGO category in individuals with type 2 diabetes who had received INT for a median of 5.6 years. VADT clinical trials.gov number: NCT 00032487.",
keywords = "Intensive glycaemic control, Nephropathy, Renal outcomes, Type 2 diabetes",
author = "{for the VADT Study Group} and Lily Agrawal and Nasrin Azad and Bahn, {Gideon D.} and Ling Ge and Reaven, {Peter D.} and Hayward, {Rodney A.} and Reda, {Domenic J.} and Emanuele, {Nicholas V.}",
note = "Funding Information: We thank C. Abraira and W. Duckworth for designing and co-chairing the original VADT. Support for obtaining data from the VA system or the Centers for Medicare and Medicaid Services was provided by the Information Resource Center of VA Health Services Research and Development (Service Directed Research numbers, 02-237 and 98-004). This manuscript represents valid work. Neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere. VADT and VADT-F have been approved by the institutional review board of each facility where they were conducted and were carried out in accordance with the Declaration of Helsinki. Members of the VADT Study Group are listed in the ESM. Supported by the Veterans Affairs Cooperative Studies Program of the department of Veterans Affairs Office of Research and Development (VA CSP #465 and #465-F), a grant (P30DK092926) from the National Institute of Diabetes and Digestive and Kidney Diseases, and grants from the National Institutes of Health (RO1HL067690 and RO1HL094775). RAH is supported, in part, by grant number P30DK092926 (MCDTR) from the National Institute of Diabetes and Digestive and Kidney Diseases. Funding Information: Funding Supported by the Veterans Affairs Cooperative Studies Program of the department of Veterans Affairs Office of Research and Development (VA CSP #465 and #465-F), a grant (P30DK092926) from the National Institute of Diabetes and Digestive and Kidney Diseases, and grants from the National Institutes of Health (RO1HL067690 and RO1HL094775). RAH is supported, in part, by grant number P30DK092926 (MCDTR) from the National Institute of Diabetes and Digestive and Kidney Diseases. Publisher Copyright: {\textcopyright} 2017, This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection.",
year = "2018",
month = feb,
day = "1",
doi = "10.1007/s00125-017-4473-2",
language = "English (US)",
volume = "61",
pages = "295--299",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",
number = "2",
}