Intensive Glycemic Control Improves Long-term Renal Outcomes in Type 2 Diabetes in the Veterans Affairs Diabetes Trial (VADT)
Authors: Lily Agrawal, Nasrin Azad, Gideon D. Bahn, Peter D. Reaven, Rodney A. Hayward, Domenic J. Reda, Nicholas V. Emanuele, Carlos Abraira, William C. Duckworth, Carl T. Hayden, Christina Paul, Danielle Arca, Rebecca Martinez Zolotor, Louisa Williams, Carl T. Hayden, Susan L. Collier, Nafis Ahmed, Angela Boyd, Domenic Reda, Thomas Moritz, Robert Anderson, Mary Ellen Vitek, Tamara Paine, Lizy Thottapurathu, Ping Luo, Ken Bukowski, Danuta Motyka, Victoria Barillas, Rodney Brown, Barbara Christine, Laurel Anfinsen, Mary Biondic, Rita Havlicek, Joe Kubal, Maureen McAuliffe, Madeline McCarren, Maria Rachelle, Linda Rose, Jerome Sacks, Tom Sindowski, Jonathan Thomas, Candice Zahora, Mike R. Sather, Jolene Day, Jeff Haroldson, Carlos Abraira, William Duckworth, Stephen N. Davis, Nicholas Emanuele, Steven Goldman, Rodney Hayward, Jennifer Marks, Thomas Moritz, Peter Reaven, Domenic Reda, Stuart Warren, Franklin Zieve, Wendy Wendell, Jeff Haroldson, Paula Harper, William G. Henderson, Robert R. Henry, M. Sue Kirkman, Madeline McCarren, Jerome Sacks, James Gavin, Emily Chew, Barbara Howard, Ted Karrison, Ivan V. Pacold, Daniel Seigel, Frank Vinicor, Barry Massie, Steven Goldman, Steven Rapcsak, Gulshan Sethi, Mark Sharon, Hoang Thai, Karen Zadina, Janice Christensen, Douglass Morrison, Peter Spooner, Alex Westerband, Barry Materson, Eliot Brinton, Ronald Klein, John A. Colwell, Ernst J. Schaefer, Carlton S. Gass, David A. Ehrmann, Paul Rue, Ernst J. Schaefer, Judith R. McNamara, Mary Brophy, Donald Humphries, Deborah Govan, Laurie McDonnell, Laura Carlton, Yugia Weng, Rodney A. Hayward, Sarah Krein, Steven Goldman, Karen Zadina, Jeremy Soule, Susan Caulder, Clare Pittman, Omayra Alston, Ronald K. Mayfield, Greg Moffitt, Julius Sagel, Frank Sanacor, Elizabeth Ganaway, Jennifer Marks, Lorraine Okur, Lucille Jones, Hermes Florez, Donna Pfeifer, Luis Samos, Andrew L. Taylor, Mark B. Zimering, Adilia Sama, Frances Rosenberg, Heidi Garcia, Norman Ertel, Leonard Pogach, John J. Shin, Felice Caldarella, Constantino Carseli, Mamta Shah, Paulette Ginier, George Arakel, Yangheng Fu, Don Tayloe, Jack E. Allen, Elizabeth Fox, Paula G. Hensley, Nicholas Emanuele, Kathleen Kahsen, Patricia Linnerud, Lily Agrawal, Nasrin Azad, Marco Marcelli, Glenn R. Cunningham, Natalie M. Nichols, Emilia Cordero, Rabih Hijazi, Farid Roman, Paromita Datta, Mariana Garcia Touza, Amale Lteif, Karen L. Moore, Christina Lazar-Robinson, Sanjay Gupta, M. Sue Kirkman, Martha Mendez, Zehra Haider, Lora Risley, Dennis Karounos, Linda Barber, Janet Hibbard, James W. Anderson, L. Raymond Reynolds, Jeff Carlsen, Robert W. Collins, Moti L. Kashyap, Barbara Matheus, Tina Rahbarnia, Anthony N. Vo, Nancy Downey, Lynette Fox, Richard M. Gonzales, C. Daniel Meyers, Subramaniam Tavintharan, Frank Q. Nuttall, Lisa Cupersmith, Kathy Dardick, Linda Kollman, Angeliki Georgopoulos, Catherine Niewoehner, Nashville Stephen N. Davis, Paula Harper, Diana Davis, Jessica Devin, Annis Marney, Julia Passyn-Dunn, Jennifer Perkins, John Stafford, Linda Balch, Patricia Harris, Robert J. Anderson, Diana Dunning, Steve Ludwig, Marlene Vogel, Cyrus DeSouza, Robert Ecklund, Sarah Doran, Claire Korolchuk, Mary McElmeel, Sarah Wagstaff, Peter Reaven, Bradley Solie, John Matchette, Christian Meyer, Sylvia Vela, Nadeem Aslam, Eliot Brinton, Joy Clark, Alisa Domb, Linda McDonald, Lynae Shurtz, R. Harsha Rao, Janice N. Beattie, Carol Franko, Frederick R. DeRubertis, David Kelly, Melisse Maser, Juleen Paul, Franklin Zieve, Susan J. Clark, Ann Grimsdale, Sonja Fredrickson, James Levy, Dianne Schroeder, Ali Iranmanesh, Barbara Dunn, Donna Arsura, Csaba Kovesdy, Suzanne Hanna, Ashraf Iranmanesh, Christy Florow, Fe Remandaban, Erica Smith, Robert R. Henry, Miriam Keller, Vanita Aroda, Charles Choe, Steven Edelman, Andrea Gasper, Dereck MaFong, Sunder Mudaliar, Deborah Oh, Rahil Bandukwala, Anna Chang, Sandeep Chaudhary, Sithophol Chinnapongse, Louie Christiansen, Neelima Chu, Dennis Kim, Mark Lupo, Manju Chandran, Ray Plodkowski, Roopa Sathyaprakash, Janet Wilson, Joseph Yu, Gina Macaraeg, Shelley Townes, Ralph DeFronzo, Lisa Johnson, Ken Cusi, Devjit Tripathy, Mandeep Bajaj, Janet Blodgett, Sangeeta Kayshup, Mary Helen Vasquez, Barbara Walz, Tess Weaver, Julio Benabe, Zuleika Mercado, Brunilda Padilla, Jocelyn Serrano-Rodriguez, Carlos Rosado, Edwin Mejias, Tania Tejera, Clorinda Geldrez, Elda Gonzalez-Melendez, Maria Natal, Maribel Rios Jimenez, Jayendra H. Shah, Wendy S. Wendel, Lynnette Scott, Lynne A. Gurnsey, Fabia A. Kwiecinski, Thomas Boyden, Merilyn G. Goldschmid, Virginia Easton
Journal: Diabetes Care (2019)

Diabetes accounts for almost 50% of cases of end-stage renal disease (ESRD) in high-income countries (1). Although the impact of intensive glycemic control on macrovascular complications is relatively modest, evidence suggests that tight glucose control may reduce kidney disease progression. The role of glucose control in preventing chronic kidney disease and ESRD continues to be of significant interest.

The Veterans Affairs Diabetes Trial (VADT) was a randomized, prospective, multicenter study in 1,791 veterans with poorly controlled type 2 diabetes, primarily to determine the impact of 5.6 years of tight versus standard glycemic control on cardiovascular events; secondary outcomes included microvascular disease. After the 5.6-year interventional period, the cohort was observationally followed for an additional 10 years (median follow-up was 15 years, ending in 2017) and provided a unique view of the impact of glycemic control on important clinical outcomes. As previously reported, baseline demographics, clinical characteristics, statin and blood pressure medicine use, and mean HbA1c (9.4 ± 2% [79.2 mmol/mol]) were balanced between the two groups (2). Participants received either intensive (INT) or standard (STD) glucose control for a median of 5.6 years. The median HbA1c achieved was 1.5% lower in INT versus STD during the intervention phase (6.9% vs. 8.4% [52 vs. 68 mmol/mol]). Subsequent diabetes care was provided by their primary health care team, and participants were followed using the Department of Veterans …