High Glycemic Variability as a Risk Factor for CKD Progression in Type 2 Diabetes with Mild-to-Moderate Kidney
Taro Saigusa1, Kentaro Watanabe1, Masahiro Takubo1
1Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, Itabashi, Japan.
Summary
Greater HbA1c variability increases chronic kidney disease (CKD) progression risk in type 2 diabetes patients with mild kidney dysfunction. Careful glycemic control is vital for preserving kidney function.
Area of Science:
- Nephrology
- Endocrinology
- Diabetes Research
Background:
- Type 2 diabetes is a leading cause of chronic kidney disease (CKD).
- Mild-to-moderate reduction in estimated glomerular filtration rate (eGFR) requires further investigation regarding CKD progression risks.
- Glycemic control variability is a potential, understudied factor in diabetic nephropathy.
Purpose of the Study:
- To evaluate the association between glycemic control variability and CKD progression in type 2 diabetes patients with mild-to-moderate kidney dysfunction.
- To identify predictors of CKD progression in this specific patient cohort.
Main Methods:
- Retrospective cohort study including 66 patients with type 2 diabetes and eGFR between 45-60 mL/min/1.73 m².
- 8-year follow-up period with annual measurements of HbA1c and eGFR.
- Analysis of eGFR slope, HbA1c fluctuations (coefficient of variation), and clinical parameters.
Main Results:
- Patients with stable eGFR showed significantly higher HbA1c fluctuations and coefficient of variation (CV) compared to those with eGFR decline (P=0.011).
- Older age was also associated with eGFR decline (P=0.049).
- A one standard deviation increase in CV was significantly associated with eGFR decline (OR, 1.99; P=0.041).
Conclusions:
- Increased glycemic variability, indicated by higher HbA1c fluctuations and CV, is linked to a greater risk of CKD progression in type 2 diabetes patients with mild-to-moderate kidney impairment.
- Maintaining stable glycemic control may be crucial for slowing CKD progression in diabetic patients.
- Further prospective studies are warranted to confirm these findings and explore intervention strategies.
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