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J Diabetes. 2017 Oct;9(10):908-919. doi: 10.1111/1753-0407.12512. Epub 2017 Jan 23.

Effect of long-term glycemic variability on estimated glomerular filtration rate decline among patients with type 2 diabetes mellitus: Insights from the Diabetic Nephropathy Cohort in Singapore.

Author information

1
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
2
Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
3
Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.

Abstract

BACKGROUND:

In the present study, we examined the association between HbA1c variability and renal disease progression based on estimated glomerular filtration rate (eGFR) decline in patients with type 2 diabetes mellitus (T2DM) in Singapore.

METHODS:

Glycemic burden and renal function were retrospectively assessed in 1628 patients in 2002-2014. Multivariable logistic regression was used to assess the relationships between HbA1c variability (expressed as HbA1c coefficient of variation [HbA1c-CV] in quartiles), HbA1c intrapersonal mean (HbA1c-IM), and eGFR decline, adjusted for baseline covariates.

RESULTS:

Among patients with relatively good glycemic control (i.e. HbA1c-IM below the median cohort value [8.0%]), HbA1c-CV Quartile 4 was associated with eGFR decline (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.10-3.25). The OR for HbA1c-CV Quartile 4 was 2.20 (95% CI 1.24-3.89) after additional adjustment for HbA1c-IM. Where HbA1c-IM was above the median cohort value, HbA1c-CV Quartiles 3 and 4 were associated with eGFR decline, with ORs of 2.60 (95% CI 1.48-4.55) and 3.29 (95% CI 1.89-5.76) respectively. After further adjusting for HbA1c-IM, the ORs for Quartiles 3 and 4 were 2.69 (95% CI 1.53-4.74) and 3.51 (95% CI 1.98-6.21), respectively.

CONCLUSIONS:

Variability in HbA1c is strongly and independently associated with eGFR decline in patients with T2DM independent of mean HbA1c. The findings may highlight the importance of sustained stable glycemic control in management of diabetes mellitus.

KEYWORDS:

2型糖尿病; HbA1c variability; HbA1c波动性; estimated glomerular filtration; progression; type 2 diabetes mellitus; 估算的肾小球滤过功能; 进展

PMID:
27935225
DOI:
10.1111/1753-0407.12512
[Indexed for MEDLINE]

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