Skip to main content
. Author manuscript; available in PMC: 2022 Jun 1.
Published in final edited form as: Am J Kidney Dis. 2021 Apr 21;77(6):969–983. doi: 10.1053/j.ajkd.2020.12.022

Table 5:

Summary of major clinical trials on intensive versus standard glycemic control on kidney outcomes.

ADVANCE (n=11,140) ACCORD (n=10,251) UKPDS (n=3,867) VADT (n=1,791) DCCT (n=1,441) EDIC (n=1,349)
Kidney-related inclusion criteria Not specified Scr ≤132.6 μmol/L Scr ≤175 μmol/L Scr ≤1.6 mg/dL Scr <1.2 mg/dL or CLcr >100 ml/min/1.73 m2; UAE <40 mg/d Scr <1.2 mg/dL or CLcr >100 ml/min/1.73 m2; UAE <40 mg/d
Follow-up Median: 5 y Mean: ~3.5 y Median: ~10 y Median: 5.6 y Mean: 6.5 y Mean: ~8 y
Diabetes type Type 2 Type 2 Type 2 Type 2 Type 1 Type 1
Diabetes duration Median: 7 y Median: ~10 y “newly diagnosed” Mean: ~11.5 y Mean: ~2.6a & ~8.6–8.9b y Mean: ~12 y
Intervention HbA1c ≤6.5% vs. standard* HbA1c <6.0% vs. 7.0%−7.9% Median HbA1c ~7.0% vs. ~7.9% Median HbA1c ~6.9% vs. 8.4% HbA1c <6.05% vs. standard None (obs follow-up of DCCT)
Mean baseline HbA1c ~7.5% ~8.1% 7.08% ~9.4% ~8.8%a & ~8.9–9.0b ~7.4d & 9.1e
Baseline eGFR, CLcr, or Scr Mean eGFR ~78.0–78.3 ml/min/1.73 m2 Median eGFR ~90 ml/min/1.73 m2 n/a Mean Scr ~1.0 mg/dL Mean CLcr ~127–128a & ~128–130b mL/min Mean CLcr ~122 mL/min
Baseline UACR or UAE* Median UACR ~14.9–15.0 μg/mg Median UACR ~1.54 mg/mmol n/a n/a Mean UAE ~12a & ~19–21b mg/d Median UAE 8.6d & 10.1e mg/d
Kidney outcomec UACR ≥30 μg/mg: HR, 0.91 (0.85–0.98); UACR >300 μg/mg: HR, 0.70 (0.57–0.85); KFRT: HR, 0.35 (0.15–0.83) UACR ≥30 mg/g: HR, 0.79 (0.69–0.90); UACR ≥300 mg/g: HR, 0.69 (0.55–0.85); KFRT or SCr >291.72 μmol/L: HR, 0.95 (0.73–1.24) UACR >30 mg/g: RR, 0.70 (0.46–1.07); “Proteinuria”: RR, 0.58 (0.23–1.43); Pcr doubling: RR, 1.25 (0.16–9.55) Any ↑ in albuminuria: 9.1% vs. 13.8% (p=0.01); From normal to UACR ≥30 mg/g: 10.0% vs. 14.7% (p=0.03); Scr doubling: 8.8% vs. 8.8% (p=0.99) Risk reduction: 39% (21%−52%) for UAE ≥40 mg/d; 54% (19%−74%) for UAE ≥300 mg/d Risk reduction: 59% (39%−73%) for UAE ≥40 mg/d; 84% (67%−92%) for UAE >300 mg/d
Risk reduction: 50% (18%, 69%)f for sustained eGFR <60 ml/min/1.73 m2
a

primary prevention cohort and

b

secondary intervention cohort of the DCCT;

c

for UKPDS, from 0–15 years of follow-up with outcome assessed every 3 years;

d

intensive and

e

conventional groups of original DCCT;

f

over median follow-up of 22 years (includes DCCT and EDIC years 1–16);

*

based on local guidelines;

**

Baseline UPCR information not available.

Abbreviations: eGFR=estimated glomerular filtration rate; UPCR=urinary protein-creatinine ratio; UACR=urinary albumin-creatinine ratio; UAE=urine albumin excretion; CLcr=creatinine clearance; HbA1c=hemoglobin A1c; RR, relative risk; obs, observational; ADVANCE, Action in Diabetes and Cardiovascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; ACCORD, Action to Control Cardiovascular Risk in Diabetes; DCC, Diabetes Control and Complications Trial; EDIC, Epidemiology of Diabetes Interventions and Complications; UKPDS, UK Prospective Diabetes Study; VADT, Veterans Affairs Diabetes Trial; n/a=not available.

Based on information in Perkovic et al 2013 (Kidney Int, https://doi.org/10.1038/ki.2012.401), Ismail-Beigi 2010 (Lancet. https://doi.org/10.1016/s0140-6736(10)60576-4); UKPDS Group 1998 (Lancet. https://doi.org/10.1016/S0140-6736(98)07019-6); Duckworth et al 2009 (NEJM, https://doi.org/10.1056/nejmoa0808431), DCCT group 1993 (NEJM, https://doi.org/10.1056/nejm199309303291401); EDIC group 2003 (JAMA. https://doi.org/10.1001/jama.290.16.2159), DCCT/EDIC group 2011 (NEJM, https://doi.org/10.1056/nejmoa1111732).