Glycated Haemoglobin A1c Variability Score Elicits Kidney Function Decline in Chinese People Living with Type 2...

Area of Science:

• Nephrology
• Endocrinology
• Diabetes Research

Background:

• Type 2 diabetes is a major cause of chronic kidney disease.
• Glycemic control variability, measured by HbA1c variability score (HVS), is increasingly recognized as a risk factor for diabetes complications.
• Understanding the impact of HVS on kidney function decline is crucial for managing diabetes.

Purpose of the Study:

• To investigate the association between HbA1c variability score (HVS) and the slope of estimated glomerular filtration rate (eGFR) in Chinese adults with type 2 diabetes.
• To quantify the risk of rapid eGFR decline associated with different levels of HVS.

Main Methods:

• A cohort study using data from the WECODe database in China (2011-2019).
• Individual-level visit-to-visit HbA1c variability was estimated using HVS (proportion of HbA1c changes ≥0.5%).
• Logistic regression and mixed-effect models were used to analyze the association between HVS and eGFR slope.

Main Results:

• The study included 2397 adults with type 2 diabetes and a median follow-up of 4.7 years.
• Compared to HVS ≤ 20%, individuals with HVS 60%-80% had 11% higher odds of rapid eGFR decline (0.93 mL/min/1.73 m²/year extra decline).
• Individuals with HVS > 80% had 26% higher odds of rapid eGFR decline (1.83 mL/min/1.73 m²/year extra decline).

Conclusions:

• Elevated HVS (>60%) is associated with a more rapid decline in kidney function among Chinese adults with type 2 diabetes.
• HbA1c variability is a significant predictor of eGFR decline, highlighting its importance in diabetes management.
• These findings emphasize the need to monitor and manage glycemic variability to preserve kidney function in diabetic patients.