Tight Sugar Control Might Not Help Kidney Function

Another one bites the dust
Another one bites the dust
And another one gone and another one gone
Another one bites the dust, eh
Hey, I'm gonna get you too
Another one bites the dust
- Queen, 1980

Back in the day, we would generalize from a study based upon a specific population and apply those findings to the population at large.  Heck, we'd even take epidemiologic observational data and flaunt that as proof of cause & effect.  Well, I'd like to think that we've matured and moved beyond that phase.  

Witness how the Women's Health Initiative (WHI) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies have upended traditional medicine.  Prior to the latter study, we used to advocate lowering blood pressure & tightening glycemic control in all diabetics regardless of severity & duration of disease.  ACCORD demonstrated to us that better glycemic control doesn't improve cardiovascular risk.  And since last fall, we now have proof that lowering blood pressure doesn't prevent 2nd strokes and that better glycemic control doesn't prevent cognitive dysfunction.

So what happened over the Memorial Day weekend?  A systematic review & meta-analysis of 28,065 adults in 7 trials followed from 2 to 15 years was published in the Archives of Internal Medicine in which the authors concluded that while intensive glycemic control reduces micro- and macroalbuminuria, lower HgbA1c did not improve what matters to patients, end stage renal disease and death from kidney disease.  So another one of our vaunted reasons for tight glycemic control bites the dust.

Yes, we test  for microalbuminuria as a marker of kidney function, but patients only really care about avoiding dialysis and death.  In other words, while we made one of our screening markers of disease look better at greater risk of hypoglycemia, we did nothing that affected patient oriented outcomes.  And isn't that our raison d'etre?  Let's use evidence based medicine to apply trial results to the appropriate population to achieve outcomes that matter to them, not the organ system researchers in the ivory towers.

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