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Glycemic control and cardiovascular disease in a high-risk chronic kidney disease population

Rachandeep Singh, Ravi Nistala, Samy I McFarlane and Adam Whaley-Connell

Diabetes is the leading cause of cardiovascular disease morbidity and mortality, and the presence of chronic kidney disease has been increasingly recognized as an independent cardiovascular disease risk factor. Sufficient evidence suggests that tighter glycemic control improves the macro- and micro-vascular complications in diabetic patients. However, the majority of the studies have not included individuals with advanced chronic kidney disease. Recent work has sought to determine the effectiveness of tighter glycemic control in diabetic kidney disease on cardiovascular mortality. Furthermore, recent evidence suggests that in addition to glycemic control in diabetic kidney disease, there are additional comorbid conditions such as obesity and hypertension that need to be considered. Lifestyle modifications in addition to glycemic control and reductions in systolic blood pressure are now recognized to be important in reducing cardiovascular disease mortality as compared with the tighter glycemic control alone.