medsarticles.com

9 Jun
2011

In the DCCT, renal involvement (nephropathy) was assessed by ti urine collections at baseline and yearly, with calculations of 24-hour urinary albumin excretion and creatinine clearances. Intensive therapy reduced the mean adjusted risk of microalbuminuria, defined as > 4C albumin/24 hours, by 34% in the primary prevention group (p = 0 and by 43% in the secondary intervention cohort (p = 0.001) . risk of albuminuria, defined as a 300 mg/24 hours, was reduced by ? in the secondary prevention group (p = 0.01). More advanced nephropathy, such as renal failure requiring dialysis, developed in very few patients. The effect of intensive treatment was maintained in various s groups defined according to age, gender, duration of type 1 diabetes, mean blood pressure, baseline HbA1c, dietary protein intake, or history of cigarette smoking.Approximately 27% of primary prevention patients assigned to standard therapy had microalbuminuria after 8 years of follow-up compared with only 15% in those in the intensive therapy group. Among second; prevention patients, approximately 40% assigned to conventional therapy vs. only 25% of these on intensive therapy had microalbuminuria after years in the trial. Thus, although intensive management was effective delaying progression to microalbuminuria in both primary and secondary prevention cohorts, its appearance was not completely prevented. Anal sis during the fourth year after completion of the DCCT in the EDIC Tri showed that the proportion of patients with an increase in urinary albumin excretion continued to be significantly lower in the intensive therapygroup. Microalbuminuria has emerged as an important risk marker f( renal failure and for cardiovascular events. *28\357\8*

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