Prevention of Diabetic Nephropathy by Tight Target Control in an Asian Population With Type 2 Diabetes Mellitus

Background: No study to date has evaluated whether multifactorial intervention can prevent diabetic nephropathy in patients with type 2 diabetes mellitus and normoalbuminuria. We evaluated the effect of tightly controlling multiple factors recommended by the American Diabetes Association (ADA) on the development and prevention of diabetic nephropathy in Chinese patients with type 2 diabetes mellitus and normoalbuminuria during a 4 1/2-year period. Methods: A longitudinal cohort study enrolled 1290 patients with type 2 diabetes and normoalbuminuria who received intensified treatment to meet the following AD A recommended goals: hemoglobin A(1c) (HbA(1c)), less than 7%; systolic blood pressure, less than 130 mm Hg; diastolic blood pressure, less than 80 mm Hg; low- density lipoprotein cholesterol, less than 100 mg/dL; triglycerides, less than 150 mg/dL; and high-density lipoprotein cholesterol, greater than 40 mg/dL for men and greater than 50 mg/dL for women. Results: During the study period, 211 patients (16.4%) developed new-onset microalbuminuria. A significant association was found between the achievement of ADA goals, including HbA(1c) level less than 7% (hazard ratio [HR], 0.729; 95% confidence interval [CI], 0.553-0.906; P = .03), systolic blood pressure less than 130 mm Hg (0.645; 0.491-0.848; P = .002), and high-density lipoprotein cholesterol level greater than 50 mg/dL for women and greater than 40 mg/dL for men (0.715; 0.537-0.951; P = .02) and the development of new-onset microalbuminuria. Conclusions: Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADA-recommended targets. This multifactorial intervention should be started in patients with diabetes and normoalbuminuria. Conclusions: Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADA-recommended targets. This multifactorial intervention should be started in patients with diabetes and normoalbuminuria.