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Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose.
Am J Med. 2013 Nov; 126(11):1017.e1-10.AJ

Abstract

BACKGROUND

This study examined whether annual variation in glycosylated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), can predict diabetic nephropathy independently of mean FPG, mean HbA1c, and other risk factors in patients with type 2 diabetes.

METHODS

A computerized database of patients with type 2 diabetes aged ≥30 years and free of diabetic nephropathy (n = 3220) who were enrolled in the Diabetes Care Management Program of China Medical University Hospital before 2007 was used in a time-dependent Cox proportional hazards regression model.

RESULTS

The incidence rates of diabetic nephropathy were 16.11, 22.95, and 28.86 per 1000 person-years in the first, second, and third tertiles of baseline HbA1c-CV, respectively; the corresponding incidence rates for FPG-CV were 9.46, 21.23, and 37.51 per 1000 person-years, respectively. After multivariate adjustment, the corresponding hazard ratios for the second and third tertiles versus the first tertile of annual HbA1c-CV were 1.18 (95% confidence interval [CI], 0.88-1.58) and 1.58 (95% CI, 1.19-2.11), respectively, and 1.55 (95% CI, 0.99-2.41) and 4.75 (95% CI, 3.22-7.01) for FPG-CV, respectively. The risks of diabetic nephropathy for HbA1c-CV and FPG-CV stratified according to age, gender, renal function, and hypertension status were provided.

CONCLUSIONS

Annual FPG and HbA1c variations have a strong association with diabetic nephropathy in patients with type 2 diabetes. Whether intervention for reducing glucose variation should be administered needs to be examined in a future study.

Authors+Show Affiliations

Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23993260

Citation

Lin, Cheng-Chieh, et al. "Risks of Diabetic Nephropathy With Variation in Hemoglobin A1c and Fasting Plasma Glucose." The American Journal of Medicine, vol. 126, no. 11, 2013, pp. 1017.e1-10.
Lin CC, Chen CC, Chen FN, et al. Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose. Am J Med. 2013;126(11):1017.e1-10.
Lin, C. C., Chen, C. C., Chen, F. N., Li, C. I., Liu, C. S., Lin, W. Y., Yang, S. Y., Lee, C. C., & Li, T. C. (2013). Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose. The American Journal of Medicine, 126(11), e1-10. https://doi.org/10.1016/j.amjmed.2013.04.015
Lin CC, et al. Risks of Diabetic Nephropathy With Variation in Hemoglobin A1c and Fasting Plasma Glucose. Am J Med. 2013;126(11):1017.e1-10. PubMed PMID: 23993260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose. AU - Lin,Cheng-Chieh, AU - Chen,Ching-Chu, AU - Chen,Fei-Na, AU - Li,Chia-Ing, AU - Liu,Chiu-Shong, AU - Lin,Wen-Yuan, AU - Yang,Sing-Yu, AU - Lee,Cheng-Chun, AU - Li,Tsai-Chung, Y1 - 2013/08/29/ PY - 2012/11/13/received PY - 2013/03/18/revised PY - 2013/04/11/accepted PY - 2013/9/3/entrez PY - 2013/9/3/pubmed PY - 2013/12/18/medline KW - Diabetic nephropathy KW - Fasting plasma glucose KW - Hemoglobin A(1c) KW - Type 2 diabetes SP - 1017.e1 EP - 10 JF - The American journal of medicine JO - Am J Med VL - 126 IS - 11 N2 - BACKGROUND: This study examined whether annual variation in glycosylated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), can predict diabetic nephropathy independently of mean FPG, mean HbA1c, and other risk factors in patients with type 2 diabetes. METHODS: A computerized database of patients with type 2 diabetes aged ≥30 years and free of diabetic nephropathy (n = 3220) who were enrolled in the Diabetes Care Management Program of China Medical University Hospital before 2007 was used in a time-dependent Cox proportional hazards regression model. RESULTS: The incidence rates of diabetic nephropathy were 16.11, 22.95, and 28.86 per 1000 person-years in the first, second, and third tertiles of baseline HbA1c-CV, respectively; the corresponding incidence rates for FPG-CV were 9.46, 21.23, and 37.51 per 1000 person-years, respectively. After multivariate adjustment, the corresponding hazard ratios for the second and third tertiles versus the first tertile of annual HbA1c-CV were 1.18 (95% confidence interval [CI], 0.88-1.58) and 1.58 (95% CI, 1.19-2.11), respectively, and 1.55 (95% CI, 0.99-2.41) and 4.75 (95% CI, 3.22-7.01) for FPG-CV, respectively. The risks of diabetic nephropathy for HbA1c-CV and FPG-CV stratified according to age, gender, renal function, and hypertension status were provided. CONCLUSIONS: Annual FPG and HbA1c variations have a strong association with diabetic nephropathy in patients with type 2 diabetes. Whether intervention for reducing glucose variation should be administered needs to be examined in a future study. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/23993260/Risks_of_diabetic_nephropathy_with_variation_in_hemoglobin_A1c_and_fasting_plasma_glucose_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(13)00462-2 DB - PRIME DP - Unbound Medicine ER -