Impact of haemoglobin A1c trajectories on chronic kidney disease progression in type 2 diabetes.
Cohort Studies
Diabetes Mellitus, Type 2
/ blood
Diabetic Nephropathies
/ blood
Disease Progression
Female
Glycated Hemoglobin
/ analysis
Humans
Kidney Function Tests
/ methods
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Renal Insufficiency, Chronic
/ blood
Risk Factors
Singapore
/ epidemiology
chronic kidney disease
haemoglobin A1c trajectory
type 2 diabetes mellitus
Journal
Nephrology (Carlton, Vic.)
ISSN: 1440-1797
Titre abrégé: Nephrology (Carlton)
Pays: Australia
ID NLM: 9615568
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
accepted:
12
11
2018
pubmed:
20
12
2018
medline:
28
2
2020
entrez:
20
12
2018
Statut:
ppublish
Résumé
To characterize haemoglobin A1c (HbA1c) trajectories and examine their associations with chronic kidney disease (CKD) progression. This was a prospective cohort study on 770 patients with type 2 diabetes mellitus (T2DM) attending a diabetes centre in 2002-2017. Group-based trajectory modelling was used to identify HbA1c trajectories. Cox proportional hazards models were used to examine association between the trajectories and CKD progression which was defined as deterioration across the Kidney Disease: Improving Global Outcomes estimated glomerular filtration rate categories with ≥25% drop from baseline. We identified four HbA1c trajectories: 'near-optimal stable' (49.1%), 'moderate stable' (37.9%), 'moderate-increasing' (6.0%) and 'high-decreasing' (7.0%). Over a median follow-up period of 4.6 years (interquartile range 2.5-5.6), CKD progression occurred in 35.6% of patients. The risk of CKD progression was significantly higher in the moderate-increasing with adjusted hazard ratios (HR) 2.23 (95% confidence interval (CI) 1.09-4.57). After additional adjustment for mean HbA1c, the association between the moderate-increasing subgroup and CKD progression remained significant at HR 3.07 (95% CI 1.08-8.77). Moderate-increasing HbA1c trajectory is associated with renal disease progression in patients with T2DM, independent of mean HbA1c. The deleterious effects of deteriorating HbA1c trajectory highlight the importance of achieving sustained good glycaemic control in diabetes management.
Substances chimiques
Glycated Hemoglobin A
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1026-1032Subventions
Organisme : Alexandra Health Fund Limited
ID : AHPL SIG II/11001
Organisme : Alexandra Health Fund Limited
ID : SIG/11029
Organisme : Alexandra Health Fund Limited
ID : SIG/12024
Informations de copyright
© 2018 Asian Pacific Society of Nephrology.
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