Does aggressive glycemic control in diabetic patients with established microvascular disease help prevent progression of kidney disease?
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For patient with type 2 diabetes, intensive glycemic control (achieving a hemoglobin A1c of ≤6.5%) results in a significant decrease in the progression to macroalbuminuria, although without clearly altering the rates of eventual dialysis. (SOR: B, based on multiple RCTs.) Given the associated adverse cardiovascular effects of intensive control, a 7% HbA1c goal is still recommended, but lower goals could be individualized if achievable without significant hypoglycemia or other adverse effects. (SOR: C, based on consensus guidelines.)
Evidence Based Practice 15(5): 01-02.