Fasting Glucose Variability as a Risk Indicator for End-Stage Kidney Disease in Patients with Diabetes: A Nationwide...

Area of Science:

• Nephrology
• Endocrinology
• Diabetology

Background:

• Diabetes mellitus is a primary driver of end-stage kidney disease (ESKD).
• Predicting ESKD risk and intervening early are critical for managing diabetic kidney disease.
• Fasting glucose variability (FGV) is increasingly recognized as a potential factor in diabetes complications.

Purpose of the Study:

• To determine if fasting glucose variability (FGV) can predict the development of end-stage kidney disease (ESKD) in individuals with diabetes.
• To identify patient subgroups particularly vulnerable to the adverse effects of glucose variability on kidney health.

Main Methods:

• A large cohort of 777,192 Korean individuals with diabetes was analyzed.
• Data from health examinations between 2005-2010 were used to calculate variability independent of the mean (VIM) of fasting glucose (FG).
• Multivariate-adjusted Cox proportional hazards models assessed the risk of incident ESKD up to 2017.

Main Results:

• Higher FGV (quartile 4) was associated with a 27% increased risk of ESKD compared to the lowest quartile (quartile 1), independent of other risk factors.
• This association was more pronounced in patients under 65, with longer diabetes duration, hypertension, dyslipidemia, and those on specific diabetes medications.
• Baseline fasting glucose levels showed a U-shaped association with ESKD risk, highlighting FGV as a distinct predictor.

Conclusions:

• Fasting glucose variability (FGV) is an independent risk factor for end-stage kidney disease (ESKD) in diabetic patients.
• FGV provides predictive value for kidney failure beyond average glucose levels.
• Targeting glucose variability may be a crucial strategy for preventing ESKD in diabetes management.