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Predictive Ability of Visit-to-Visit Variability of HbA1c Measurements for the Development of Diabetic Kidney

Yunyi Yan1, Nozomi Kondo1, Kentaro Oniki1

  • 1Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.

Journal of Diabetes Research
|February 1, 2022
PubMed

Insights

Visit-to-visit variability in glycated hemoglobin (HbA1c) is linked to diabetic kidney disease (DKD) risk. The HbA1c area under the curve (HbA1c-AUC) shows promise as a prognostic indicator for microalbuminuria in type 2 diabetes.

Area of Science:

  • Endocrinology
  • Nephrology
  • Metabolic Disorders

Background:

  • Glycemic control is crucial for managing type 2 diabetes mellitus (T2DM).
  • Visit-to-visit variability in glycated hemoglobin (HbA1c) has emerged as a potential risk factor for diabetic complications.
  • Diabetic kidney disease (DKD) is a major microvascular complication of diabetes, characterized by albuminuria.

Purpose of the Study:

  • To investigate the association between different measures of visit-to-visit HbA1c variability and the risk of developing or progressing diabetic kidney disease (DKD).
  • To identify the most effective index for quantifying HbA1c variability in predicting DKD risk.
  • To explore the role of oxidative stress in this relationship.

Main Methods:

  • A clinic-based retrospective longitudinal study involving 699 Japanese patients with T2DM.
  • Calculation of HbA1c variability using HbA1c standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), change score (HbA1c-HVS), and area under the curve (HbA1c-AUC) over 3 years.
  • Cox proportional hazards models, propensity score matching, and bootstrap analyses were employed to assess associations with DKD incidence and progression.

Main Results:

  • Both HbA1c-SD and HbA1c-AUC were significantly associated with the incidence of microalbuminuria, independent of mean HbA1c levels.
  • These findings were robust and replicated across different statistical analyses.
  • Elevated HbA1c-SD and HbA1c-AUC were also correlated with higher levels of oxidized human serum albumin (HSA), a marker of oxidative stress.

Conclusions:

  • Visit-to-visit HbA1c variability is an independent risk factor for microalbuminuria in T2DM patients, potentially mediated by oxidative stress.
  • The HbA1c-AUC, a novel variability index, demonstrates potential as a prognostic indicator for predicting microalbuminuria risk.
Abstract

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