Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Jun;36(6):1735-41.
doi: 10.2337/dc12-2420.

Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial

TODAY Study Group
Collaborators
Randomized Controlled Trial

Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial

TODAY Study Group. Diabetes Care. 2013 Jun.

Erratum in

  • Diabetes Care. 2013 Aug;36(8):2448

Abstract

Objective: Among adolescents with type 2 diabetes, there is limited information regarding incidence and progression of hypertension and microalbuminuria. Hypertension and microalbuminuria assessments made during the TODAY clinical trial were analyzed for effect of treatment, glycemic control, sex, and race/ethnicity.

Research design and methods: A cohort of 699 adolescents, 10-17 years of age, <2 years duration of type 2 diabetes, BMI ≥ 85%, HbA1c ≤ 8% on metformin therapy, controlled blood pressure (BP), and calculated creatinine clearance >70 mL/min, were randomized to metformin, metformin plus rosiglitazone, or metformin plus intensive lifestyle intervention. Primary study outcome was loss of glycemic control for 6 months or sustained metabolic decompensation requiring insulin. Hypertension and microalbuminuria were managed aggressively with standardized therapy to maintain BP <130/80 or <95th percentile for age, sex, and height and microalbuminuria <30 μg/mg.

Results: In this cohort, 319 (45.6%) reached primary study outcome, and 11.6% were hypertensive at baseline and 33.8% by end of study (average follow-up 3.9 years). Male sex and higher BMI significantly increased the risk for hypertension. Microalbuminuria was found in 6.3% at baseline and rose to 16.6% by end of study. Diagnosis of microalbuminuria was not significantly different between treatment arms, sex, or race/ethnicity, but higher levels of HbA1c were significantly related to risk of developing microalbuminuria.

Conclusions: Prevalence of hypertension and microalbuminuria increased over time among adolescents with type 2 diabetes regardless of diabetes treatment. The greatest risk for hypertension was male sex and higher BMI. The risk for microalbuminuria was more closely related to glycemic control.

Trial registration: ClinicalTrials.gov NCT00081328.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative incidence curves for time to diagnosis of hypertension during TODAY by treatment group (A), occurrence of glycemic failure (B), race/ethnicity (C), and sex (D).
Figure 2
Figure 2
Cumulative incidence curves for time to diagnosis of microalbuminuria during TODAY by treatment group (A), occurrence of glycemic failure (B), race/ethnicity (C), and sex (D).
See this image and copyright information in PMC

Comment in

References

    1. de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA 2011;305:2532–2539 - PMC - PubMed
    1. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR, UKPDS Study Group Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes 2006;55:1832–1839 - PubMed
    1. Bilous R. Microvascular disease: what does the UKPDS tell us about diabetic nephropathy? Diabet Med 2008;25(Suppl. 2):25–29 - PubMed
    1. de Galan BE, Perkovic V, Ninomiya T, et al. ADVANCE Collaborative Group Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol 2009;20:883–892 - PMC - PubMed
    1. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003;290:2159–2167 - PMC - PubMed

Publication types

Associated data

Grants and funding