Insulin-treated T2D: albuminuria as a therapeutic target

Takeaway

• Regression of albuminuria (e.g. via better blood pressure or glycaemic control) was associated with reduction in cardiovascular (CV) events and all-cause mortality in patients with insulin-treated type 2 diabetes (T2D) and nephropathy in routine practice.

Why this matters

• Levels of albuminuria should be considered not only as an important risk marker but also as an important therapeutic target for CV and mortality prevention in patients with T2D.

Study design

• Study used data from a large UK Primary Care database (The Health Improvement Network Database) and identified a cohort of insulin users with T2D and nephropathy (baseline urinary albumin-creatinine ratio [ACR] ≥300 mg/g) between 2007 and 2014.
• Cohort was followed up for 5 years for primary endpoints of all-cause mortality and CV events (a composite of non-fatal myocardial infarction and stroke).
• Funding: Medical Research Council and Arthritis Research UK.

Key results

• A total of 11,074 patients with insulin-treated T2D (mean age, 62.3 years; mean HbA1c, 8.7% [1.8 mmol/mol]) were included.  
• 5-year survival was reduced in patients with ACR >300 mg/g vs those with ACR <300 mg/g (log-rank P value <.001)
• Within a total follow-up period of 43,393 person-time, 682 deaths with a crude incidence rate of 15.7 per 1000 person-years (95% CI, 14.6-17.0) were reported.
• After adjustment, the risks for CV events and all-cause mortality was 27 and 31% lower in patients with ACR <300 mg/g (aHR, 0.73; 95% CI, 0.54-0.98; P=.041 and aHR, 0.69; 95% CI, 0.52-0.91; P=.008), respectively, vs patients whose ACR levels remained above 300 mg/g.

Limitations

• Residual confounding.