An interventional study of Multifactorial Intervention in Diabetic Nephropathy, sponsored by Cook County Health. Completed at 1 site in United States. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2024-08-26.
Sponsored by Cook County Health · Not applicable, Interventional, and Treatment
The purpose of this study is to compare the progression of kidney disease in subjects with Diabetes mellitus type 2 and Advanced Diabetic Nephropathy treated by routine follow-up as a general care and in subjects treated by multi-factorial intervention in the Diabetes-Renal Clinic.
In this study, the overall objective is comparison of progression of renal insufficiency in subjects with Advanced Diabetic Nephropathy (CKD stages 3 and 4) randomized into multifactorial intervention in the Diabetes-Renal Clinic (study group) and into usual care (control group). The multifactorial intervention includes the following: 1. Blood pressure control to the goal of \<130/80mmHg and renal protection with reduction of proteinuria to \<0.5g/day using a protocol that includes therapy with ACE inhibitors, ARBs or their combination. 2. Tight glucose control using SMBG and Lantus/Apidra self-escalation regimen. 3. Use of hypolipidemic therapy to achieve targets of LDL of \< 70 mg/dl, HDL > 40/50 mg/dl (males/females) [since you said that HDL is not a target because there are no meds for it I deleted HDL;] and triglycerides of less than 200 mg/dl. 4. Patient enhanced self-management provided by combined diabetes-renal education curriculum (taught by certified diabetes and renal educators). 5. Behavior and social intervention (motivational interviews and social assessment) provided as needed by social workers. 6. Intense case management that includes close follow-up of visits, laboratory monitoring and other self-adherence behaviors. 7. Weight loss with lifestyle and diet modification.
Control Group will keep on receiving the usual treatment that they used to receive from their respective clinics and the Diabetes-Renal team would not alter their therapy or interfere in their management.
3,840 studies on the registry are indexed under Kidney Diseases; 500 are open to participants now.
This study's enrollment of 120 is above the median of 70 across 2,640 interventional studies indexed under Kidney Diseases.
Browse Kidney Diseases studies →Cook County Health is the lead sponsor of 28 studies on the registry; 1 is open to participants now.
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The participant must have documented Advanced Diabetic Nephropathy (ADN) defined as presence of proteinuria or micro/macro-albuminuria and impaired GFR (by MDRD equation) corresponding to Chronic Kidney Disease (CKD) stages 3-4 (moderate-severe i.e. estimated GFR >15ml/min and \<60ml/min).
A. Presence of macroalbuminuria B. Presence of microalbuminuria if no therapy with ACE inhibitors or ARBs C. Presence of current microalbuminuria and previous documentation of macroalbuminuria D. Presence of current microalbuminuria and previous documentation of Diabetic Retinopathy or laser therapy E. If only microalbuminuria and no A, B, C or D US of kidney shows NL size.
Exclusion Criteria:
Study group will receive multifactorial intervention for advanced diabetic nephropathy: Elements of multifactorial intervention: 1. BP control of \<130/80mmHg and renal protection with reduction of proteinuria to \<0.5g/day using therapy with ACE inhibitors and/or ARBs. 2. Tight glucose control with target of HbA1C of 7% and below using SMBG and Lantus/Apidra regimen. 3. Use of hypolipidemic therapy to achieve targets of LDL \< 70 mg/dl, HDL \> 40/50 mg/dl (M/F)and TG \< 200 mg/dl. 4. Patient enhanced self-management provided by combined diabetes-renal education curriculum. 5. Behavior and social intervention 6. Intense case management that includes close follow-up of visits, laboratory monitoring and other self-adherence behaviors carried out by clinical research coordinators.
Other: Multifactorial Intervention
Control Group will keep on receiving the usual treatment that they used to receive from their respective clinics and the Diabetes-Renal team would not alter their therapy or interfere in their management.
Study group will receive multifactorial intervention for advanced diabetic nephropathy: Elements of multifactorial intervention: 1. BP control of \<130/80mmHg and renal protection with reduction of proteinuria to \<0.5g/day using therapy with ACE inhibitors and/or ARBs. 2. Tight glucose control with target of HbA1C of 7% and below using SMBG and Lantus/Apidra regimen. 3. Use of hypolipidemic therapy to achieve targets of LDL \< 70 mg/dl, HDL \> 40/50 mg/dl (M/F)and TG \< 200 mg/dl. 4. Patient enhanced self-management provided by combined diabetes-renal education curriculum. 5. Behavior and social intervention 6. Intense case management that includes close follow-up of visits, laboratory monitoring and other self-adherence behaviors carried out by clinical research coordinators.
Delay in development in end-stage renal failure in subjects with Advanced Diabetic Nephropathy (CKD stages 3 and 4)
Time to reaching End Stage Renal Disease (ESRD)
Time frame: 2 years
This study is completed, as verified in Aug 2024. You cannot join it, but the record below documents what was studied.
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Cook County Health