[Efect of short term glycemic control on microalbuminuria and glomerular filtration rate in type 2 diabetic patients with poor glycemic control]. / Efeitos do controle glicêmico obtido em curto prazo sobre a microalbuminúria e a filtração glomerular em pacientes diabéticos do tipo 2 com controle glicêmico precário.

INTRODUCTION: The intensive glucose control significantly reduces the risk of microvascular complications, including nephropathy. OBJECTIVES: We assess the impact of glycemic control through calculation of weekly mean glycemia (WMG) and glycemic variability (GV) on 24 hours ambulatory blood pressure (ABPM), urinary albumin excretion (UAE) and glomerular filtration rate (GFR). METHODS: 53 patients with type 2 diabetes mellitus (DM2) were randomly divided into two groups to receive conventional or intensive treatment, which included weekly visits for medication adjustments and implementation of an educational plan for six weeks. RESULTS: We observed glycemic control (WMG < 150 mg/dL and VG < 50) in 75% (n = 21) of the patients on the intervention treatment (IT) (n = 28), and in 24% (n = 6) of the ones on the conventional treatment (CT) (n = 25) (p < 0.001). Considering patients of the two groups, 14 out of the 27 patients who achieved glycemic control showed initial mean systolic blood pressure (SBP) > 120 mmHg which was reduced from 138.4 ± 10.1 to 127.8 ± 11.6 mmHg (p = 0.023) at the end of week six. Reductions in SBP and diastolic BP (DBP) during wakefulness and sleep did not occur in the group (n = 17) without glycemic control and with SBP > 120 mmHg. Initially, 15 patients had GFR > 120 mL/min, and after six weeks, only the subgroup that achieved glycemic control (n = 7) showed a reduction of 137.2 ± 16 to 122.2 ± 25.2 mL/min (p = 0.02). At the beginning of the study, another fifteen patients presented with microalbuminuria. After six weeks, regardless of whether they achieved glycemic control or not, there was reduction in UAE, from 63.0 ± 43.1 to 24.8 ± 19.5 mg/g creatinine (p = 0.02). CONCLUSION: Thus short term glycemic control resulted in reductions of BP, GFR and the UAE in patients with DM2, which are beneficial for renal protection.

Efeitos do controle glicêmico obtido em curto prazo sobre a microalbuminúria e a filtração glomerular em pacientes diabéticos do tipo 2 com controle glicêmico precário / Efect of short term glycemic control on microalbuminuria and glomerular filtration rate in type 2 diabetic patients with poor glycemic control

INTRODUÇÃO: O controle intensivo da glicemia reduz significativamente o risco de desenvolvimento de complicações microvasculares, incluindo a nefropatia. OBJETIVOS: Foi avaliado o impacto do controle glicêmico, por meio do cálculo da glicemia média semanal (GMS) e variabilidade glicêmica (VG), sobre a pressão arterial (PA) nas 24 horas (MAPA), excreção urinária de albumina (EUA) e taxa de filtração glomerular (TFG). MÉTODOS: 53 pacientes com diabetes mellitus tipo 2 (DM2), dividida aleatoriamente em dois grupos para receber tratamento convencional ou intensivo. Esse último incluía visitas semanais para ajustes da medicação e aplicação de um plano educacional durante seis semanas. RESULTADOS: Observou-se controle glicêmico (GMS < 150 mg/dL e VG < 50) em 75% (n = 21) dos pacientes do grupo intervenção (GI) (n = 28) e em 24% (n = 6) do grupo convencional (GC) (n = 25) (p < 0,001). Dos 27 pacientes dos dois grupos que obtiveram controle glicêmico, 14 apresentavam inicialmente média da PA sistólica (PAS) > 120 mmHg e que se reduziu de 138,4 ± 10,1 para 127,8 ± 11,6 mmHg (p = 0,023) ao final das seis semanas. Foram observadas reduções da PAS e PA diastólica (PAD) na vigília e durante o sono, que não ocorreram no grupo (n = 17) sem controle glicêmico e PAS >120 mmHg. Inicialmente, 15 pacientes apresentavam TFG >120 mL/min, sendo que após seis semanas, apenas o subgrupo que alcançou controle glicêmico (n = 7) mostrou redução de 137,2 ± 16 para 122,2 ± 25,2 mL/min (p = 0,02). No inicio do estudo, outros quinze pacientes apresentavam microalbuminúria. Após seis semanas, independente de terem alcançado o controle glicêmico preconizado, observou-se redução da EUA de 63,0 ± 43,1 para 24,8 ± 19,5 mg/g de creatinina (p = 0,02). CONCLUSÃO: Assim, o controle glicêmico obtido em curto prazo resultou na redução da PA, da TFG e da EUA nos pacientes com DM2 que apresentavam alterações desses parâmetros, alterações benéficas no que se refere à proteção renal.

INTRODUCTION: The intensive glucose control significantly reduces the risk of microvascular complications, including nephropaty. OBJECTIVES: We assess the impact of glycemic control through calculation of weekly mean glycemia (WMG) and glycemic variability (GV) on 24 hours ambulatory blood pressure (ABPM), urinary albumin excretion (UAE) and glomerular filtration rate (GFR). METHODS: 53 patients with type 2 diabetes mellitus (DM2) were randomly divided into two groups to receive conventional or intensive treatment, which included weekly visits for medication adjustments and implementation of an educational plan for six weeks. RESULTS: We observed glycemic control (WMG < 150 mg/dL and VG < 50) in 75% (n = 21) of the patients on the intervention treatment (IT) (n = 28), and in 24% (n = 6) of the ones on the conventional treatment (CT) (n = 25) (p < 0.001). Considering patients of the two groups, 14 out of the 27 patients who achieved glycemic control showed initial mean systolic blood pressure (SBP) > 120 mmHg which was reduced from 138.4 ± 10.1 to 127.8 ± 11.6 mmHg (p = 0.023) at the end of week six. Reductions in SBP and diastolic BP (DBP) during wakefulness and sleep did not occur in the group (n = 17) without glycemic control and with SBP > 120 mmHg. Initially, 15 patients had GFR > 120 mL/min, and after six weeks, only the subgroup that achieved glycemic control (n = 7) showed a reduction of 137.2 ± 16 to 122.2 ± 25.2 mL/min (p = 0.02). At the beginning of the study, another fifteen patients presented with microalbuminuria. After six weeks, regardless of whether they achieved glycemic control or not, there was reduction in UAE, from 63.0 ± 43.1 to 24.8 ± 19.5 mg/g creatinine (p = 0.02). CONCLUSION: Thus short term glycemic control resulted in reductions of BP, GFR and the UAE in patients with DM2, which are beneficial for renal protection.