Correlation between glycaemic variability and prognosis in diabetic patients with CKD

Glycaemic variability (GV), rather than glucose level, has been shown to be an important factor associated with in-hospital mortality. The coefficient of variation of glucose (GLUCV) is one of the methods used to evaluate GV. However, the clinical significance of GLUCV in diabetes mellitus (DM) patients diagnosed with chronic kidney disease (CKD) as a risk factor for long-term adverse changes is unknown.

In this retrospective study, we extracted data of adult DM patients diagnosed with CKD from the Medical Information Mart for Intensive Care (MIMIC-IV). We sought to investigate the relationship between GV and in-hospital mortality as well as 30-day mortality. A non-parametric test was used to compare baseline characteristics between groups. Kaplan-Meier analysis and Cox regression model were used to analyse the risk factors associated with in-hospital and 30-day mortality.

A total of 1572 DM patients with CKD were included in our data analysis. The quartile of the GLUCV values was used to assign subjects to 4 groups: GLUCV1 (GLUCV < 24), GLUCV2 (24 ≤ GLUCV < 31), GLUCV3 (31 ≤ GLUCV < 39) and GLUCV 4 (GLUCV ≥ 39). COX regression analysis revealed that the GLUCV was an independent risk factor for in-hospital and 30-day mortality [GLUCV2 group (HR = 0.639, 95% CI: 0.454-0.899, p = 0.010), GLUCV3 group (HR = 0.668, 95% CI: 0.476-0.936, p = 0.019), and GLUCV3 group (HR = 0.726, 95% CI: 0.528-0.999, p = 0.049)]. The Kaplan-Meier survival curve was steeper in the GLUCV1 and GLUCV4 groups, and the survival rate decreased in a time-dependent manner.

Herein, we validated GV as a mortality risk factor for DM patients with CKD. Therefore, monitoring and adjusting GV in hospitalized patients might have a significant treatment benefit.