We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Poor Glycemic Control Is Associated With More Rapid Kidney Function Decline After the Onset of Diabetic Kidney Disease.
- Authors
Shah, Hetal S; McGill, Janet B; Hirsch, Irl B; Wu, Chunyi; Galecki, Andrzej; Boer, Ian H de; Mauer, Michael; Doria, Alessandro
- Abstract
Background The role of glycemic control and its variability on the rate of kidney function decline after the onset of diabetic kidney disease (DKD) remains unclear. Methods The association between baseline glycated hemoglobin (HbA1c) and rates of estimated glomerular filtration rate (eGFR) loss during follow-up was examined by mixed-effects linear regression in 530 individuals with type 1 diabetes and early-to-moderate DKD from the Preventing Early Renal Loss (PERL) trial and 2378 individuals with type 2 diabetes and established DKD from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. The benefit of intensive vs standard glycemic control in slowing eGFR decline was examined in ACCORD. The associations between continuous glucose monitoring-derived short-term glycemic variability indices and rate of eGFR decline were also evaluated in PERL. Results A higher baseline HbA1c was associated with a more negative eGFR slope in both PERL and ACCORD (−0.87 and −0.27 mL/min/1.73 m2/year per Hba1c unit increment, P <.0001 and P =.0002, respectively). In both studies, the strength of this association progressively increased with increasing levels of albuminuria (P for interaction <.05). Consistent with this, the benefit of intensive glycemic control on eGFR decline was greater in ACCORD participants with severe rather than moderate albuminuria (+1.13 vs + 0.26 mL/min/1.73 m2/year, P =.01). No independent associations were found in PERL between short-term glycemic variability indices and rate of eGFR decline. Conclusion In both type 1 and type 2 diabetes, poor glycemic control is associated with a more rapid rate of glomerular filtration rate decline after DKD onset, especially in persons with severe albuminuria.
- Subjects
GLYCEMIC control; DIABETIC nephropathies; KIDNEY physiology; TYPE 1 diabetes; TYPE 2 diabetes; GLYCOSYLATED hemoglobin
- Publication
Journal of Clinical Endocrinology & Metabolism, 2024, Vol 109, Issue 8, p2124
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgae044