Endocrine Abstracts (2011) 26 P676

Remission of diabetic nephropathy in type 2 diabetic Asian population: role of tight glucose and blood pressure control

Y T Hsieh1, M C Hsieh2,3 & S T Tu2

1Department of Ophtahlmology, Buddhist Tzu Chi Genral Hospital, Taipei Branch, New Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; 3Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.

Background: Asian has higher prevalence of diabetic nephropathy and end-stage renal disease as compared to Caucasian. No study to date has evaluated whether multifactorial intervention was associated with remission of microalbuminuria in type 2 diabetic Asian population. We evaluated the effect of tightly controlling multiple factors on the remission of diabetic nephropathy in type 2 diabetic Chinese with microalbuminuria.

Materials and methods: A total of 587 type 2 diabetic patients with microalbuminuria were collected in a longitudinal cohort study. Cohort members received intensified treatment to meet the following ADA recommended goals: HbA1c<7%, SBP<130 mmHg, DBP<80 mmHg, LDL-C<100 mg/dl, TG<150 mg/dl, HDL-C>40 mg/dl for men and >50 mg/dl for women. Remission of microalbuminuria was defined as shift of albumin-creatinine ratio (ACR) from mircoalbuminuria to normoalbuminuria.

Results: During the 4.5 year period, 210 (35.8%) patients achieved remission to normoalbuminuria. A significant association was found between remission of microalbuminuria and the achievement of ADA goals, including HbA1c<7% (hazard ratio (HR)=1.345; 95% confidence interval (CI): 1.010–1.792; P=0.04), and systolic blood pressure <130 mmHg (HR=1.516; 95% CI: 1.100–2.089; P=0.01). Intensive SBP control (<120 mmHg) was significantly associated with remission of microalbuminuria (HR=2.076; 95% CI: 1.347–3.198; P<0.001).

Conclusion: The remission of diabetic nephropathy could be achieved under multifactorial intervention. Therapeutic focus on remission by tight glycemic and blood pressure control should be considered in Asian population with diabetes and microalbuminuria.

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