Abstract 14095: Differential Effects of Intensive Glucose Lowering in Patients With Type 2 Diabetes, With or Without Mild to Moderate Chronic Kidney Disease at Baseline
Background: Intensive glucose lowering was associated with higher mortality rates in the main Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. We investigated the impact of mild and moderate (Stage 1-3) chronic kidney disease (CKD) on the effects of intensive compared to standard glucose lowering in patients with type 2 diabetes.
Methods: Among ACCORD participants, 1,449 (14.3%) had Stage 1 CKD, 1,366 (13.5%) Stage 2 CKD, and 821 (8%) Stage 3 CKD, while 6,506 (64.2%) were free of CKD at baseline. All-cause and cardiovascular mortality was evaluated along with the primary outcome (a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and prespecified secondary outcomes, in high-risk patients with diabetes, randomized to intensive (A1c goal <6%) or standard (A1c goal 7-7.9%) glucose goals.
Results: In patients with CKD, intensive glucose lowering was associated with significantly higher risk for all-cause mortality (HR: 1.31; 95% CI: 1.06-1.60) and cardiovascular mortality (HR: 1.41; 95% CI: 1.05-1.90) compared to standard glucose lowering. No significant differences were observed in non-CKD patients for all-cause mortality (HR: 1.08; 95% CI: 0.87-1.34) or cardiovascular mortality (HR: 1.14; 95% CI: 0.818-1.584, test for interaction P=NS). There were no significant differences for the primary outcome between intensive and standard therapy both in CKD (HR: 0.87; 95% CI: 0.73-1.03) and non-CKD (HR: 0.94; 95% CI: 0.79-1.12) patients.
Conclusions: These findings suggest that intensive glucose lowering in high risk diabetic patients with CKD may results in an increased risk for cardiovascular and all-cause mortality. Renal function status should be considered before intensive glucose lowering is advocated in patients with type 2 diabetes.
- © 2013 by American Heart Association, Inc.