Intensive glucose control in patients with diabetes prevents onset and progression of microalbuminuria, but effects on end-stage kidney disease are still uncertain.

Commentary on:  Ruospo M, Saglimbe VM, Palmer SC, et al . Glucose targets for preventing diabetic kidney disease and its progression.  Cochrane Database Syst Rev 2017;6:CD010137. Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD). Randomised controlled trials (RCTs) suggest that intensive glycaemic control reduces progression of albuminuria, but effects on later DKD stages and cardiovascular outcomes are less clear. This systematic review evaluated the benefits and harms of intensive versus standard glycaemic control on the onset and progression of DKD and mortality. This meta-analysis of published tabular data included RCTs assigning patients with diabetes (type 1 or 2) with and without kidney disease to intensive (glycated haemoglobin (HbA1c) <7% or fasting blood glucose (FBG) <6.6 mmol/L) or standard glycaemic control (HbA1c ≥7% or FBG ≥6.6 mmol/L). Primary outcomes were doubling of serum creatinine, ESKD, and death or non-fatal myocardial infarction or stroke. Secondary outcomes included measures of albuminuria, serum creatinine, measures of glomerular …