Strategies for glucose control in a study population with diabetes, renal disease and anemia (Treat study)

Weinrauch, Larry A.; D’Elia, John A.; Finn, Peter; Lewis, Eldrin F.; Desai, Akshay S.; Claggett, Brian; Cooper, Mark E.; McGill, Janet B.

doi:10.1016/j.diabres.2015.12.021

Cited by 13 publications

(9 citation statements)

References 40 publications

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“…The observation that in stable renal transplant population, hypertension therapy for diabetic patients may require more complex drug regimens is similar to those noted in both single-center and multinational trials enrolling patients with diabetes and renal disease. 15,16 Our study confirms these reports and demonstrates that type 2 diabetic patients required significantly greater numbers of antihypertensives than non-diabetic patients of the similar age (Table 2). One could postulate that among diabetic transplant recipients with relatively resistant …”

supporting

confidence: 81%

Does diabetes impact therapeutic immunomodulation therapy decisions for kidney transplant recipients? Data from the Folic Acid for Vascular Outcome Reduction in Transplant (FAVORIT) trial

Weinrauch

D’Elia

Weir

et al. 2017

IJNRD

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Abstract:Although survival has improved for kidney transplant recipients over the past several decades, long-term survival in diabetic cohorts still is significantly less than that of non-diabetic cohorts. We hypothesized that among stable kidney transplant recipients, there might be differences between subgroups with and without diabetes with respect to prevalence of prior cardiovascular events and post-transplant antihypertensive and immunosuppressive therapy. We performed a post hoc analysis of participants in the Folic Acid for Vascular Outcome Reduction in Transplant (FAVORIT) trial, a multicenter international trial of 4110 prevalent kidney transplant recipients enrolled from 2002 to 2007 evaluating the effect of homocysteine-lowering vitamin therapy on cardiovascular outcomes. There were 2447 participants without diabetes, 166 with type 1 diabetes, and 1447 with type 2 diabetes at study entry, which occurred on average 4 years post-transplant. Recipients with diabetes had a greater prevalence of prior cardiovascular events, were more likely to have required multiple medications to control hypertension, and were more likely to have received tacrolimus as opposed to cyclosporine than the non-diabetic transplant recipients (all p<0.001). The effect of differences in treatment of non-diabetic vs diabetic cohorts after stable renal transplantation upon outcomes has not yet been studied and could provide additional information that might lead to improved care.

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supporting

confidence: 81%

Does diabetes impact therapeutic immunomodulation therapy decisions for kidney transplant recipients? Data from the Folic Acid for Vascular Outcome Reduction in Transplant (FAVORIT) trial

Weinrauch

D’Elia

Weir

et al. 2017

IJNRD

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“…20 Although the TREAT trial was not designed to evaluate prevalence of resistant hypertension or results of antihypertensive therapy, it would appear that use of multiple antihypertensive agents at baseline was also greater in lower tiers of renal function and that antidiabetes medications varied according to baseline eGFR as well. 21 The current evaluation extends this observation to a cohort of hypertensive type 2 diabetic patients with wider ranges of renal function.…”

Section: Discussionmentioning

confidence: 55%

“…The Trial to Reduce Cardiovascular Endpoints With Aranesp Therapy (TREAT) enrolled 4038 patients during the years 2005 to 2009 (a similar time frame to our database) in order to determine whether programmed use of darbepoetin improved healthcare outcomes among patients with type 2 diabetes and moderately severe renal insufficiency. 20 Although the TREAT trial was not designed to evaluate prevalence of resistant hypertension or results of antihypertensive therapy, it would appear that use of multiple antihypertensive agents at baseline was also greater in lower tiers of renal function and that antidiabetes medications varied according to baseline eGFR as well . The current evaluation extends this observation to a cohort of hypertensive type 2 diabetic patients with wider ranges of renal function.…”

Section: Discussionmentioning

confidence: 76%

Renal Function Alters Antihypertensive Regimens in Type 2 Diabetic Patients

Weinrauch

Bayliss

Segal

et al. 2016

J of Clinical Hypertension

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To determine the prevalence of multidrug antihypertensive therapy (MDAT), records were evaluated for patients with both type 2 diabetes and hypertension during a 5‐year period at Joslin Diabetes Center. Hypertension control was defined as requiring multiple drugs if three or more antihypertensive drugs were used, one of which must be a diuretic (unless patient is receiving dialysis), or use of four or more antihypertensive drugs, one of which a diuretic (unless patient is receiving dialysis) was established. The objective was to determine the prevalence of multidrug requirement for hypertensive therapy in relationship to four levels of renal function estimated by the Modification of Diet in Renal Disease formula for glomerular filtration rate (GFR). Among 10,151 patients, mean estimated GFR was 80 mL/min. Using standard (ASN) classification for renal function, we noted the following breakdown of MDAT use: Estimated GFR Drugs, Mean No. ≥3 Drugs, No. (%) ≥4 Drugs, No. (%) <303.1379 (67)214 (38)30–602.71233 (55)538 (24)60–902.01279 (33)458 (12)>901.5600 (17)185 (5) Prevalence of multidrug antihypertensive therapy is markedly increased in the presence of reduced renal function.

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“…This observation (currently awaiting publication) confirms a similar observation we previously reported in an international trial in a population with moderately severe renal dysfunction. 5 Insulin resistance represents a nexus between obesity, type 2 diabetes, renal disease, and hypertension and may be a potential metabolic target for control of each as seen in dramatic changes resulting from bariatric surgery. 6,7 Larry A.…”

Section: To the Editormentioning

confidence: 99%