Abstract
Background/AimsThis study examined associations of visit-to-visit variability of glycemic control with annual decline in estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes attending an outpatient clinic.MethodsIntrapersonal mean and coefficient of variation (CV) of 8-12 measurements of HbA1c and those of 4-6 measurements of fasting and post-breakfast plasma glucose (FPG and PPG, respectively) during the first 12 months after enrollment were calculated in a cohort of 168 patients with type 2 diabetes. Annual changes in eGFR were computed using 52 (median) creatinine measurements obtained over a median follow-up of 6.0 years. Multivariate linear regressions assessed the independent correlates of changes in eGFR.ResultsCV-HbA1c (standardized β、-0.257、p = 0.004) were significantly and log urine albumin/creatinine ratio (standardized β、-0.155、p = 0.085) and smoking (standardized β、-0.186、p = 0.062) tended to be associated with annual eGFR decline independently of mean HbA1c, age, sex, BMI, waist circumference, diabetes duration and therapy, means and CVs of FPG, PPG and systolic blood pressure, baseline eGFR, and uses of anti-hypertensive and lipid-lowering medications. Association between HbA1c variability and renal function decline was stronger in patients with albumin/creatinine ratio ≧ 30 mg/g than in those with normoalbuminuria (r = -0.400, p = 0.003 and r = -0.169, p = 0.07, respectively).ConclusionsConsistency of glycemic control is important to preserve kidney function in type 2 diabetic patients, in particular, in those with nephropathy.
Highlights
Diabetes is an important cause of mortality and morbidity worldwide, through both direct clinical sequelae and increased mortality from cardiovascular and kidney diseases [1]
We asked the question whether HbA1c variability might directly associated with annual decline in estimated glomerular filtration rate in patients with type 2 diabetes attending a long-term follow-up in a single outpatient clinic
We are not aware of previous studies to determine whether HbA1c variability might directly associated with annual decline rate in estimated glomerular filtration rate (eGFR) in patients with type 2 as well as type 1 diabetes
Summary
Diabetes is an important cause of mortality and morbidity worldwide, through both direct clinical sequelae and increased mortality from cardiovascular and kidney diseases [1]. Long-term glycemic control, as expressed by hemoglobin (Hb) A1c levels, is the main risk factor for the development of microvascular complications including diabetic kidney disease [2, 3]. Variation of HbA1c, a reflection of long-term glycemic fluctuation, was found to increase the risk of renal and cardiovascular complications [8,9,10,11,12,13,14,15,16,17]. We asked the question whether HbA1c variability might directly associated with annual decline in estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes attending a long-term follow-up in a single outpatient clinic
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