A study of multifactorial intervention in type 2 diabetes and chronic kidney disease

Date of ISAC Approval: 
14/10/2015
Lay Summary: 
Type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) are associated with mortality, development of cardiovascular disease (CVD), and declining of renal function. The frequency of CKD appears to be increasing in patients with T2DM. A multifactorial intervention includes use of drugs to lower blood glucose, blood pressure and cholesterol and use of aspirin, which has been shown to be effective in patients with T2DM with a small amount of urine protein. However, the effectiveness of this approach has not been verified yet in patients with T2DM and CKD. This study aims to evaluate the implementation of multifactorial intervention in diabetic patients with CKD over time. The study will also evaluate the associations of a multifactorial intervention with mortality, CVD and declining of renal function. This study will provide useful information about the implementation of multifactorial intervention strategies into patients with T2DM and CKD, which will enable these patients to live longer and healthier.
Technical Summary: 
Type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) are associated with mortality, development of cardiovascular disease (CVD), and declining of renal function (eg, progression to end-stage renal failure or ESRF). The frequency of CKD appears to be increasing in patients with T2DM. Evidence has emerged on the effectiveness of multifactorial interventions on mortality, including tight blood glucose control, renin-angiotensin system blockers, aspirin, and lipid-lowering drugs, at reducing mortality and progression of CKD in diabetic patients with persistent microalbuminuria. However, the effectiveness of this approach has not been verified yet in patients with T2DM and CKD. This study aims to evaluate the implementation of multifactorial intervention in diabetic patients with CKD over time. The study will also evaluate the association of a multifactorial intervention with mortality, CVD, progression to ESRF or renal replacement therapy, doubling of serum creatinine and acute kidney injury. Analyses will be adjusted for a wide range of confounders including duration of diabetes and deprivation category. Linked external datasets will contribute to evaluation of renal and cardiovascular outcomes and causes of deaths. This study will provide useful information about the implementation of multi-factorial intervention strategies into patients with T2DM and CKD.
Health Outcomes to be Measured: 
Mortality and causes of deaths CVD events including coronary heart disease (CHD) and stroke Renal outcomes, including progression to ESRF or renal replacement therapy, doubling of serum creatinine and acute kidney injury
Collaborators: 

Shota Hamada - Chief Investigator - Kings College London
Professor Martin Gulliford - Collaborator - Kings College London
Shota Hamada - Corresponding Applicant - Kings College London

Linkages: 
HES Admitted;Patient IMD;Practice IMD (Standard)