Journal
JOURNAL OF DIABETES AND ITS COMPLICATIONS
Volume 37, Issue 9, Pages -Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jdiacomp.2023.108556
Keywords
Diabetes mellitus; Type 2; Prevention; Kidney; Nephropathy; Albuminuria; Glomerular filtration rate; Metformin
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This study analyzed the incidence of kidney disease in the Diabetes Prevention Program Outcomes Study (DPPOS) based on the originally randomized treatment groups. The results showed that the risk of developing kidney disease was increased in participants who developed diabetes, but it did not differ based on the treatment groups.
Aims: We analyzed the incidence of kidney disease in the Diabetes Prevention Program Outcomes Study (DPPOS) by originally randomized treatment group assignment: Intensive Lifestyle (ILS), Metformin (MET) or Placebo (PLB). Methods: The current analyses used a time-to-event approach in which the primary outcome was kidney disease, ascertained as urine albumin-to-creatinine ratio (ACR) = 3.39 mg/mmol (30 mg/g) or eGFR <45 mL/min/ 1.73m2, with confirmation required at the next visit, or adjudicated end-stage kidney disease (ESKD). Results: At a median of 21 years following randomization in DPP, diabetes development was reduced in both the ILS (HR 0.73 [95%CI = 0.62, 0.85]) and MET groups (HR 0.85 [0.73, 0.99]) compared to the PLB group. Although risk for developing the primary kidney disease outcome was higher among those with incident diabetes compared to those without (HR 1.81 [1.43, 2.30]), it did not differ by intervention groups (ILS vs. PLB 1.02 (0.81, 1.29); MET vs. PLB 1.08 (0.86, 1.35). There was a non-significant metformin by age interaction (p = 0.057), with metformin being beneficial for kidney disease in the younger but potentially harmful in the older participants. Conclusions: Development of kidney disease was increased in participants who developed diabetes but did not differ by original treatment group assignment. Clinical trial registrations: Diabetes Prevention Program (DPP) Clinical trial reg. no. NCT00004992 DPP Outcomes Study (DPPOS) Clinical trial reg. no. NCT0038727
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