Direct association of visit-to-visit HbA1c variation with annual decline in estimated glomerular filtration rate in patients with type 2 diabetes

Journal of Diabetes & Metabolic Disorders

Tsutomu Kazumi³  Keisuke Fukuo²  Miki Kurata²  Mayu Terazawa-Watanabe⁴  Ayaka Tsuboi¹  Akiko Takenouchi¹ 

[1] Postgraduate School of Food Sciences and Nutrition, Nishinomiya, Japan;Research Institute for Nutrition Sciences, Mukogawa Women’s University, 6-46, Ikebiraki-cho, Nishinomiya 663-8558, Hyogo, Japan;Diabetes Division, Sadamitsu Hospital, Kakogawa 675-0005, Hyogo, Japan;Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Japan

关键词: eGFR;    Kidney function;    Standard deviation;    HbA1c;   

Others  :  1224980
DOI  :  10.1186/s40200-015-0201-y

 received in 2015-06-21, accepted in 2015-09-01,  发布年份 2015

【 摘 要 】

Background/Aims

This 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.

Methods

Intrapersonal 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.

Results

CV-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).

Conclusions

Consistency of glycemic control is important to preserve kidney function in type 2 diabetic patients, in particular, in those with nephropathy.

【 授权许可】

   
2015 Takenouchi et al.

【 图 表 】

Fig. 1.

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