Advance on Study: Its Long Term Benefits of Kidney Protection

Abstract

Diabetes mellitus (DM) is increasing, and Indonesia is one of the top 10 countries with the most prevalent in DM. It is associated with an approximately three-fold risk of all cardiovascular diseases, and a substantial reduction in life expectancy, Micro and macrovascular complications are the major cause of morbidity and mortality, however, much of the morbidity associated with long-term vascular complications can be substantially reduced by interventions that achieve glucose levels close to the nondiabetic range. Chronic kidney disease (CKD) is recognized as one of the strongest risk factors for cardiovascular disease, particularly in the presence of diabetes, conferring a substantial increase in the risk ol death and hospitalization (3). Despite the implementation of "best practice" standards of care for lifestyle modification, blood pressure lowering, and reninangiotensin-aldosterone system blockade, there remains a high level of progression to end stage renal disease (ESRD) for those with diabetic kidney disease. The UKPDS, DCCT, DECODE study have provide strong evidence that vigorous treatment of diabetes to achieve tight blood glucose control of FPG, HbA1c, and 2hPPG as well, can decrease morbidity and mortality of the disease by decreasing its micro- and macro-vascular complications. ADVANCE study provides a lesson that a strategy of intensive glucose control, involving modified release gliclazide and other drugs as required, that lowered the glycated hemoglobin value to 6.5% yielded a 10% relative reduction in the combined outcome of major macrovascular and microvascular events, primarily as a consequence of a 21% relative reduction in nephropathy. lntensified multifactorial intervention including glucose control, hypertension, dyslipidemia and other emerging risk factors, has been shown to reduce the risk of cardiovascular complications in may studies, and becomes new strategy in current day management, to provide optimal health-care status for people with diabetes. ADVANCEON was a post-trial follow-up study of surviving ADVANCE trial patients. After following the ADVANCE trial cohort for total of 9.9 years, it was shown that a prior period of intensive glucose control continues to protect against the development of end stage kidney disease (ESKD) in patients with type 2 diabetes. The patients who appear to benefit the most are those with preserved kidney function, with intermediate effects in the group with CKD stage 1 or 2 and lesser effects in participants with CKD stage 3 or greater at baseline