Intensive therapy and progression to clinical @entity633 in XXXX with insulin dependent diabetes mellitus and microalbuminuria. Microalbuminuria Collaborative Study Group, United Kingdom.

@entity633 @entity1 @entity101 @entity6
OBJECTIVE: To study the effect of intensive therapy of @entity6 on the progression to clinical @entity633 in insulin dependent @entity6 @entity1 with microalbuminuria. DESIGN: Randomised controlled clinical trial of intensive versus conventional therapy of @entity6 for a median of 5 years (range 2-8). SETTING: Nine hospital based specialist @entity6 centres in England and Wales. SUBJECTS: 70 European insulin dependent @entity6 @entity1 aged 17-59 years with microalbuminuria (albumin excretion 30-199 micrograms/min), but without arterial @entity101 , recruited from the nine hospital based specialist @entity6 centres. INTERVENTIONS: Intensive @entity6 therapy was allocated to 36 @entity1 (27 @entity1 , 9 @entity1 ) and conventional @entity6 therapy to 34 (24 @entity1 , 10 @entity1 ). MAIN OUTCOME MEASURES: Development of clinical @entity633 , defined as albumin excretion greater than 200 micrograms/min on at least two consecutive occasions, and rate of change of albumin excretion. RESULTS: Mean glycated haemoglobin concentration, similar at baseline in the two groups (intensive therapy group 10.3% (SEM 1.9%), conventional therapy group 9.8% (1.6%)), fell significantly (by 14%) in the intensive therapy group only. A significant glycaemic separation between the two groups was maintained for up to three years. Progression to clinical @entity633 occurred in six @entity1 in each group. Blood pressure, similar at baseline, fell significantly by 1 mm Hg (95% confidence interval -4.20 to 1.43) per year in the conventional therapy group, but the difference in the rate of blood pressure change between the groups was not significant. Independent of treatment assignment, a mean blood pressure above the group mean (93.6 mm Hg), but not the glycated haemoglobin concentration, predicted progression to clinical @entity633 (relative risk 4.2, 95% confidence interval 1.3 to 13.0). CONCLUSIONS: Intensive therapy with improved glycaemic control for three years had no impact on the progression of @entity633 in insulin dependent @entity6 @entity1 with microalbuminuria. The reduction in blood pressure in the conventional therapy group may have affected outcome--in that arterial blood pressure rather than glycated haemoglobin concentration seemed to be the main predictor of progression from microalbuminuria to clinical @entity633 .
