Fasting blood glucose--a missing variable for GFR-estimation in type 1 diabetes?
Petter Bjornstad1, R Brett McQueen2, Janet K Snell-Bergeon3
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America.
Plos One
|May 1, 2014
Summary
In type 1 diabetes (T1D), higher blood glucose levels are linked to increased estimated glomerular filtration rate (eGFR). This association may inaccurately detect diabetic nephropathy, particularly with fluctuating glucose levels.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Diabetic nephropathy risk is assessed using estimated glomerular filtration rate (eGFR) in type 1 diabetes (T1D).
- Hyperglycemia is known to affect GFR in T1D, and glucose variability can bias eGFR measurements.
Purpose of the Study:
- To investigate the hypothesis that simultaneously measured blood glucose influences eGFR in adults with T1D.
Main Methods:
- Longitudinal multivariable mixed-models analyzed data from the Coronary Artery Calcification in Type 1 diabetes (CACTI) study over 6 years.
- Included subjects with T1D and complete data on blood glucose and cystatin C for at least one of three visits.
Main Results:
- Adjusted models showed a positive association between simultaneous blood glucose and eGFRCYSTATIN C (β±SE: 0.14±0.04 per 10 mg/dL, p<0.0001).
- Higher blood glucose was also associated with hyperfiltration (OR: 1.04, 95% CI: 1.01-1.07 per 10 mg/dL, p=0.02).
Conclusions:
- Simultaneous blood glucose has an independent positive effect on eGFRCYSTATIN C in T1D.
- This association may bias the early detection of diabetic nephropathy, especially in individuals with glucose variability.
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