Salvatore De Cosmo1, Francesca Viazzi2, Antonio Pacilli1, Carlo Giorda3, Antonio Ceriello4, Sandro Gentile5, Giuseppina Russo6, Maria Chiara Rossi7, Antonio Nicolucci7, Pietro Guida8, Paolo Di Bartolo9, Roberto Pontremoli2. 1. Department of Medical Sciences, IRCCS Casa Sollievo Della Sofferenza, S. Giovanni Rotondo, FG, Italy. 2. Università Degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy. 3. Diabetes and Metabolism Unit, ASL Turin 5, Chieri, TO, Italy. 4. Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain. 5. Department of Clinical and Experimental Medicine, 2nd University of Naples, Naples, Italy. 6. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 7. Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, CH, Italy. 8. Associazione Medici Diabetologi, Roma, Italy. 9. Diabetes Unit, ASL Della Romagna, Ravenna, Italy.
Abstract
BACKGROUND: Chronic kidney disease (CKD) entails a worse cardiovascular outcome. The aim of our work was to study the relationship between CKD and the achievement of recommended targets for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) in a real-life sample of patients with type 2 diabetes mellitus (T2DM). METHODS: We analysed a sample of 116 777 outpatients from the Network of the Italian Association of Clinical Diabetologists; all patients had T2DM and at least one measurement of HbA1c, LDL-c, BP, serum creatinine and albuminuria in the year 2010. The outcome was the achievement of HbA1c, LDL-c and BP values as recommended by International Guidelines. RESULTS: In the entire sample, the mean value of HbA1c was 7.2 ± 1.2%, of LDL-c was 102 ± 33 mg/dL and of BP was 138/78 ± 19/9 mmHg. CKD and its components were associated with poor glycaemic and BP control, notwithstanding greater use of glucose and BP-lowering drugs, while no association was found with LDL-c values. Factors independently related to unsatisfactory glycaemic control included female gender, body mass index, duration of disease and high albuminuria. Men, older people and those taking statins were more likely to reach LDL-c target levels. Male gender, age and high albuminuria strongly affected the achievement of BP targets. CONCLUSIONS: CKD or its components, mainly high albuminuria, are associated with failure to reach therapeutic targets, especially for HbA1c and BP, despite a greater use of drugs in patients with T2DM.
BACKGROUND:Chronic kidney disease (CKD) entails a worse cardiovascular outcome. The aim of our work was to study the relationship between CKD and the achievement of recommended targets for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) in a real-life sample of patients with type 2 diabetes mellitus (T2DM). METHODS: We analysed a sample of 116 777 outpatients from the Network of the Italian Association of Clinical Diabetologists; all patients had T2DM and at least one measurement of HbA1c, LDL-c, BP, serum creatinine and albuminuria in the year 2010. The outcome was the achievement of HbA1c, LDL-c and BP values as recommended by International Guidelines. RESULTS: In the entire sample, the mean value of HbA1c was 7.2 ± 1.2%, of LDL-c was 102 ± 33 mg/dL and of BP was 138/78 ± 19/9 mmHg. CKD and its components were associated with poor glycaemic and BP control, notwithstanding greater use of glucose and BP-lowering drugs, while no association was found with LDL-c values. Factors independently related to unsatisfactory glycaemic control included female gender, body mass index, duration of disease and high albuminuria. Men, older people and those taking statins were more likely to reach LDL-c target levels. Male gender, age and high albuminuria strongly affected the achievement of BP targets. CONCLUSIONS:CKD or its components, mainly high albuminuria, are associated with failure to reach therapeutic targets, especially for HbA1c and BP, despite a greater use of drugs in patients with T2DM.
Authors: Johannes F E Mann; Vivian A Fonseca; Neil R Poulter; Itamar Raz; Thomas Idorn; Søren Rasmussen; Bernt Johan von Scholten; Ofri Mosenzon Journal: Clin J Am Soc Nephrol Date: 2020-03-04 Impact factor: 8.237