Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Diabetes

Glycemic control and outcomes in people with diabetes and CKD

Poor glycemic control is considered harmful in people with diabetes and chronic kidney disease; however, the ideal hemoglobin A1c target continues to be elusive. What can we learn from new observational evidence published by Shurraw et al. in the Archives of Internal Medicine?

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Histogram of observed HbA1c values in people with stage 3 or 4 chronic kidney disease.

References

  1. Gerstein, H. C. et al. Effects of intensive glucose lowering in type 2 diabetes. N. Engl. J. Med. 358, 2545–2559 (2008).

    Article  CAS  Google Scholar 

  2. Patel, A. et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N. Engl. J. Med. 358, 2560–2572 (2008).

    Article  CAS  Google Scholar 

  3. Duckworth, W. et al. Glucose control and vascular complications in veterans with type 2 diabetes. N. Engl. J. Med. 360, 129–139 (2009).

    Article  CAS  Google Scholar 

  4. Stratton, I. M. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321, 405–412 (2000).

    Article  CAS  Google Scholar 

  5. Khaw, K. T. et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann. Intern. Med. 141, 413–420 (2004).

    Article  CAS  Google Scholar 

  6. Zoungas, S. et al. Severe hypoglycemia and risks of vascular events and death. N. Engl. J. Med. 363, 1410–1418 (2010).

    Article  CAS  Google Scholar 

  7. Shurraw, S. et al. Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study. Arch. Intern. Med. 171, 1920–1927 (2011).

    Article  Google Scholar 

  8. Currie, C. J. et al. Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study. Lancet 375, 481–489 (2010).

    Article  CAS  Google Scholar 

  9. Riddle, M. C. et al. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care 33, 983–990 (2010).

    Article  Google Scholar 

  10. Zoungas, S. et al. Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. Diabetologia http://dx.doi.org/10.1007/s00125-011-2404–1.

Download references

Acknowledgements

S. Zoungas is supported by a Heart Foundation of Australia Career Development Award.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sophia Zoungas.

Ethics declarations

Competing interests

Sophia Zoungas has received speaker honoria from Servier, MSD, Novartis, Novo Nordisk, Boehringer Ingelheim, Sanofi Aventis, AstraZeneca and Bristol-Myers Squibb, and served on external advisory boards for MSD, Novo Nordisk, Sanofi Aventis and Boehringer Ingelheim.

John Chalmers holds a research grant from Servier as principal investigator for ADVANCE and ADVANCE-ON. J Chalmers has received lecturing fees and served on external advisory boards for Servier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zoungas, S., Chalmers, J. Glycemic control and outcomes in people with diabetes and CKD. Nat Rev Nephrol 8, 133–134 (2012). https://doi.org/10.1038/nrneph.2012.18

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2012.18

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing