Glycemic control and renal function decline in patients with chronic coronary syndrome: A multicenter cohort study
An-Yu Cheng1,2, Chin-Chou Huang1,3,4, Hsin-Bang Leu3,5
1School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Insights
For patients with diabetes and coronary artery disease, an HbA1c target of 6.5-6.9% is associated with lower risks of kidney complications. This finding aids in managing diabetes and preventing renal events in high-risk cardiac patients.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Diabetes mellitus is a significant risk factor for renal complications, particularly in patients with coronary artery disease (CAD).
- Optimal glycemic control is crucial for managing diabetes, but specific hemoglobin A1c (HbA1c) targets for patients with both diabetes and chronic coronary syndrome (CCS) are not well-defined.
Purpose of the Study:
- To determine the ideal hemoglobin A1c (HbA1c) targets for patients diagnosed with both diabetes and chronic coronary syndrome (CCS).
- To investigate the association between different HbA1c levels and the incidence of renal complications in this patient cohort.
Main Methods:
- An observational cohort study involving 1,223 patients with CCS, with 698 having diabetes, was conducted using data from a multicenter registry.
- Patients were stratified by diabetes status and HbA1c levels. Renal events, defined as declines in estimated glomerular filtration rate (eGFR) >25% or >50%, were the primary outcome.
- Cox proportional hazards regression models were utilized to analyze the relationship between glycemic control and renal function preservation.
Main Results:
- Over a mean follow-up of 3.2 years, the highest incidence of minor renal events occurred in diabetic patients with HbA1c ≥7.5% (25.1%) and those with HbA1c <6.5% (21.2%).
- Compared to non-diabetic individuals, adjusted hazard ratios for minor renal events were highest for diabetic patients with HbA1c ≥7.5% (3.06) and lowest for those with HbA1c 6.5-6.9% (1.32).
- Diabetic patients with HbA1c levels of 7.0-7.4% (1.75) and <6.5% (2.59) also showed increased risks compared to the non-diabetic group.
Conclusions:
- Achieving an HbA1c level between 6.5% and 6.9% is linked to a reduced risk of renal complications in patients with diabetes and chronic coronary syndrome.
- These findings suggest a specific glycemic control target may be beneficial for mitigating kidney disease progression in this high-risk population.
Aims/Introduction:
Diabetes mellitus significantly contributes to renal complications, especially in patients with coronary artery disease (CAD). Effective glycemic control is important; however, the ideal hemoglobin A1c (HbA1c) targets for this population remain uncertain. This observational cohort study aimed to identify appropriate HbA1c targets for patients with diabetes and chronic coronary syndrome.
Materials And Methods:
This study included 1,223 patients with chronic coronary syndrome, which were identified from a multicenter cohort registry study. Among them, there were 698 patients with diabetes. Patients were categorized based on their diabetes status and HbA1c levels. The primary outcome was the incidence of minor and major renal events, defined as a decline in the estimated glomerular filtration rate (eGFR) of more than 25% and 50%. Cox proportional hazards regression models were employed to assess the impact of glycemic control on renal function.
Results:
Over a mean follow-up of 3.2 ± 2.0 years, the highest incidences of minor renal events were noted in the group with diabetes and HbA1c ≥ 7.5% (25.1%), followed by diabetes and HbA1c < 6.5% (21.2%). Compared to the group without diabetes, the adjusted hazard ratios (95% confidence intervals) for minor renal events in the groups with diabetes and HbA1c ≥ 7.5%, HbA1c 7.0-7.4%, HbA1c 6.5-6.9%, and HbA1c < 6.5% were 3.06 (2.08-4.50), 1.75 (1.08-2.84), 1.32 (0.81-2.23), and 2.59 (1.58-4.24), respectively.
Conclusions:
Achieving HbA1c of 6.5 to 6.9% is associated with a reduced risk of renal complications in patients with diabetes and chronic coronary syndrome.
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