0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Glycemic Control and Cardiorenal Outcomes in Patients With Advanced Chronic Kidney Disease: Relative or Absolute Risks?  Comment on “Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease”

David C. Goff, MD, PhD
Arch Intern Med. 2011;171(21):1927-1928. doi:10.1001/archinternmed.2011.520.
Text Size: A A A
Published online

Extract

Diabetes mellitus (DM) confers very high risk for cardiovascular disease (CVD).1 Chronic kidney disease (CKD) is a common complication of DM that further increases risk of CVD, the development of end-stage renal disease (ESRD), and other complications.2 Multiple interventions have been tested in patients with DM with the hope that these interventions might reduce the risk of CVD and microvascular complications.3 Unfortunately, persons with CKD have been excluded or, at least, underrepresented in these trials. For example, on the one hand, in order to use metformin in a manner consistent with its product label in the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes), we excluded patients with elevated levels of creatinine, and, therefore, most individuals with CKD.4 On the other hand, the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial included individuals with CKD.5 The ADVANCE investigators have reported the efficacy of the blood pressure (BP) lowering intervention on cardiovascular and renal outcomes in participants with CKD6; however, they have not yet published the results of their glucose-lowering intervention in this subgroup. Nevertheless, the results of the ADVANCE BP-lowering trial in CKD may be informative.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com
brightcove.createExperiences();