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Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose

Cheng-Chieh Lin1, Ching-Chu Chen, Fei-Na Chen

  • 1Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.

The American Journal of Medicine
|September 3, 2013
PubMed

Insights

Annual variations in glycosylated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) significantly predict diabetic nephropathy in type 2 diabetes patients. Reducing glucose variability may be a future therapeutic target.

Area of Science:

  • Endocrinology
  • Nephrology
  • Diabetes Mellitus Research

Background:

  • Type 2 diabetes is a leading cause of chronic kidney disease.
  • Diabetic nephropathy risk is multifactorial, including glycemic control.
  • The role of glycemic variability in predicting nephropathy requires further investigation.

Purpose of the Study:

  • To determine if annual variations in HbA1c and FPG predict diabetic nephropathy.
  • To assess the independent predictive value of glycemic variability (CV) against mean glucose levels.
  • To evaluate these associations in patients with type 2 diabetes.

Main Methods:

  • Utilized a time-dependent Cox proportional hazards regression model.
  • Analyzed data from 3220 type 2 diabetes patients aged ≥30 years, free of nephropathy at baseline.
  • Included variables such as mean HbA1c, mean FPG, and other risk factors.

Main Results:

  • Higher tertiles of annual HbA1c-CV and FPG-CV were associated with increased diabetic nephropathy incidence.
  • Multivariate analysis showed significant hazard ratios for HbA1c-CV (1.58 for highest tertile) and FPG-CV (4.75 for highest tertile).
  • Risk stratification revealed varying impacts of glycemic variability based on age, gender, renal function, and hypertension.

Conclusions:

  • Annual variations in FPG and HbA1c are strongly associated with diabetic nephropathy in type 2 diabetes.
  • Glycemic variability, particularly FPG-CV, appears to be an independent predictor of nephropathy.
  • Further studies are needed to confirm if interventions targeting glucose variation can reduce nephropathy risk.
Abstract

Keywords:
Diabetic nephropathyFasting plasma glucoseHemoglobin A(1c)Type 2 diabetes

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