So what happened over the Memorial Day weekend? A systematic review & meta-analysis of 28,065 adults in 7 trials followed from 2 to 15 years was published in the Archives of Internal Medicine in which the authors concluded that while intensive glycemic control reduces micro- and macroalbuminuria, lower HgbA1c did not improve what matters to patients, end stage renal disease and death from kidney disease. So another one of our vaunted reasons for tight glycemic control bites the dust.
Yes, we test for microalbuminuria as a marker of kidney function, but patients only really care about avoiding dialysis and death. In other words, while we made one of our screening markers of disease look better at greater risk of hypoglycemia, we did nothing that affected patient oriented outcomes. And isn't that our raison d'etre? Let's use evidence based medicine to apply trial results to the appropriate population to achieve outcomes that matter to them, not the organ system researchers in the ivory towers.