Poor Control of Plasma Triglycerides Is Associated with Early Decline of Estimated Glomerular Filtration Rates in New-Onset Type 2 Diabetes in China: Results from a 3-Year Follow-Up Study.

Chuan Wang,Fuqiang Liu,Lingshu Wang,Daniela Foti,Li Chen,Xinguo Hou,Fei Yan,Kai Liang

doi:10.1155/2020/3613041

Abstract

Objective Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD). Even after strict control of obesity, hyperglycemia, and hypertension, some patients still progress rapidly. Previous studies suggested diabetic dyslipidemia might be one of the factors responsible for this high residual risk. This study aims to explore the impact of long-term lipid control on renal outcome in new-onset type 2 diabetes mellitus (T2DM). Methods We conducted a 3-year follow-up study, involving 283 subjects with new-onset T2DM, and observed the effect of baseline and follow-up metabolic abnormalities, especially dyslipidemia, on the early damage of kidney function using multiple logistic regression analysis. Results After 3 years follow-up, patients achieved a better control of body weight, hypertension, and blood glucose. The most reduced eGFR group shared the least reduced BMI and LDL-C, as well as the greatest increase in TG levels. Only TG in the follow-up, not any of the baseline data, nor obesity, blood glucose, BP, or LDL-C in the follow-up, was found to be significantly correlated with the most reduced eGFR. Compared with patients with constantly abnormal TG levels, the risks were even higher in the subjects who experienced a transition from normal TG to hypertriglyceridemia (OR = 2.576 versus OR = 2.184, after multiple adjustment), and by tight controlling of TG, patients started with abnormal baseline TG levels could reduce the risk of DKD progression to the same low levels as the TG-constantly-normal group. Conclusion This study emphasized the importance of long-term TG control in East Asian patients with new-onset T2DM: TG control can delay the decline of kidney function in the early stage of DKD, and reversal of hypertriglyceridemia may undo the risks of the past. It is time to pay more attention to the control of TG in new-onset T2DM.

Highlights

Diabetic kidney disease (DKD) is one major microvascular complication of type 2 diabetes mellitus (T2DM) and has been the most common cause of end-stage renal disease (ESRD) in Western countries [1], which ranks the second in China [2]
These studies mainly focused on the relationship between baseline lipid levels and DKD in subjects with previously diagnosed T2DM; few studies explored the impact of enhanced lipid control on the renal outcome in new-onset diabetes
The results of the follow-up showed a better control of body weight, hypertension, and blood glucose with decreased body mass index (BMI), BP, and HbA1c

Summary

Introduction

Diabetic kidney disease (DKD) is one major microvascular complication of type 2 diabetes mellitus (T2DM) and has been the most common cause of end-stage renal disease (ESRD) in Western countries [1], which ranks the second in China [2]. The progression of renal function decline in DKD is insidious and rapid, and lacking effective treatment for ESRD makes it very important to find and control risk factors for DKD at a stage as early as possible [5]. The associations of TG and HDL-C with the development of DKD had been investigated by several studies [10, 11] These studies mainly focused on the relationship between baseline lipid levels and DKD in subjects with previously diagnosed T2DM; few studies explored the impact of enhanced lipid control on the renal outcome in new-onset diabetes. In order to clarify this problem and achieve the early identification, warning, and control of DKD, we conducted a 3-year follow-up study to observe the effect of baseline and follow-up metabolic abnormalities, especially dyslipidemia, on the early damage of kidney function in new-onset T2DM patients

Methods

Results

Conclusion