Limits...
Glycated hemoglobin and the risk of kidney disease and retinopathy in adults with and without diabetes.

Selvin E, Ning Y, Steffes MW, Bash LD, Klein R, Wong TY, Astor BC, Sharrett AR, Brancati FL, Coresh J - Diabetes (2010)

Bottom Line: During a median of 14 years of follow-up of individuals without diagnosed diabetes at baseline, clinical categories of glycated hemoglobin were associated with risk of chronic kidney disease, with adjusted hazard ratios (HRs) of 1.12 (0.94-1.34) and 1.39 (1.04-1.85) for glycated hemoglobin 5.7-6.4% and ≥6.5%, respectively, as compared with <5.7% (P trend = 0.002).In the absence of diagnosed diabetes, glycated hemoglobin was cross sectionally associated with the presence of moderate/severe retinopathy, with adjusted odds ratios of 1.42 (0.69-2.92) and 2.91 (1.19-7.11) for glycated hemoglobin 5.7-<6.5% and ≥6.5%, respectively, compared with <5.7% (P trend = 0.011).We did not observe significant thresholds in the associations of glycated hemoglobin with kidney disease risk or retinopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. lselvin@jhsph.edu

ABSTRACT

Objective: Glycated hemoglobin was recently recommended for use as a diagnostic test for diabetes. We examined the association between 2010 American Diabetes Association diagnostic cut points for glycated hemoglobin and microvascular outcomes (chronic kidney disease, end-stage renal disease [ESRD], and retinopathy) and formally tested for the presence of risk thresholds in the relationships of glycated hemoglobin with these outcomes.

Research design and methods: Prospective cohort and cross-sectional analyses of 11,357 participants (773 with a history of diagnosed diabetes) from the Atherosclerosis Risk in Communities (ARIC) Study.

Results: During a median of 14 years of follow-up of individuals without diagnosed diabetes at baseline, clinical categories of glycated hemoglobin were associated with risk of chronic kidney disease, with adjusted hazard ratios (HRs) of 1.12 (0.94-1.34) and 1.39 (1.04-1.85) for glycated hemoglobin 5.7-6.4% and ≥6.5%, respectively, as compared with <5.7% (P trend = 0.002). The corresponding HRs for ESRD were 1.51 (0.82-2.76) and 1.98 (0.83-4.73), respectively (P trend = 0.047). In the absence of diagnosed diabetes, glycated hemoglobin was cross sectionally associated with the presence of moderate/severe retinopathy, with adjusted odds ratios of 1.42 (0.69-2.92) and 2.91 (1.19-7.11) for glycated hemoglobin 5.7-<6.5% and ≥6.5%, respectively, compared with <5.7% (P trend = 0.011). Risk associations were stronger among individuals with a history of diabetes. We did not observe significant thresholds in the associations of glycated hemoglobin with kidney disease risk or retinopathy.

Conclusions: These data from a community-based, biracial population support the use of new 2010 American Diabetes Association glycated hemoglobin cut points for the diagnosis of diabetes.

Show MeSH

Related in: MedlinePlus

Adjusted HR of incident chronic kidney disease according to baseline glycated hemoglobin value. The figures show adjusted HRs from restricted cubic spline models. The shaded area is the 95% CI. The models are centered at the median (5.5%, 5.4%, and 7.4% in the total population, nondiabetic, and diabetic participants, respectively) and truncated at the 2.5th and the 97.5th percentiles of glycated hemoglobin in each population. The HRs were adjusted for age, sex, and race (black or white), low-density and high-density cholesterol levels, log transformed triglyceride level, BMI, waist-to-hip ratio, hypertension (yes or no), family history of diabetes (yes or no), education (less than high school, high school or equivalent, or college or above), alcohol use (currently, formerly, or never), physical activity index score, and smoking status (current smoker, former smoker, or never smoked). The model in A is further adjusted for diabetes medication use. The data are shown on a natural-log scale. (A high-quality color representation of this figure is available in the online issue.)
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3012185&req=5

Figure 2: Adjusted HR of incident chronic kidney disease according to baseline glycated hemoglobin value. The figures show adjusted HRs from restricted cubic spline models. The shaded area is the 95% CI. The models are centered at the median (5.5%, 5.4%, and 7.4% in the total population, nondiabetic, and diabetic participants, respectively) and truncated at the 2.5th and the 97.5th percentiles of glycated hemoglobin in each population. The HRs were adjusted for age, sex, and race (black or white), low-density and high-density cholesterol levels, log transformed triglyceride level, BMI, waist-to-hip ratio, hypertension (yes or no), family history of diabetes (yes or no), education (less than high school, high school or equivalent, or college or above), alcohol use (currently, formerly, or never), physical activity index score, and smoking status (current smoker, former smoker, or never smoked). The model in A is further adjusted for diabetes medication use. The data are shown on a natural-log scale. (A high-quality color representation of this figure is available in the online issue.)

Mentions: We observed significant trends of increasing risk of chronic kidney disease and ESRD with higher values of baseline glycated hemoglobin in individuals without a history of diabetes even after adjustment for known risk factors (Table 2). Among individuals without diabetes, clinical categories of glycated hemoglobin (<5.7, 5.7–<6.5, and ≥6.5%) were stronger predictors of chronic kidney disease and ESRD as compared with categories of fasting glucose (<100, 100–<126, and ≥126 mg/dl). Diabetes history was strongly associated with risk of chronic kidney disease and ESRD even after adjustment (Table 2). Figure 2 depicts the adjusted HRs from the restricted cubic spline models for chronic kidney disease by baseline glycated hemoglobin value in the total population and, separately, in nondiabetic and diabetic participants. The restricted cubic spline models for the association of fasting glucose are presented in supplementary Fig. 1 in the online appendix available at http://diabetes.diabetesjournals.org/cgi/content/full/db10-1198/DC1. The C statistics from the unadjusted Cox model for glycated hemoglobin (modeled continuously) and risk of chronic kidney disease in the total population, diabetic participants, and nondiabetic participants were 0.608, 0.644, and 0.562, respectively. The C statistics for ESRD were 0.760, 0.619, and 0.648, respectively. The C statistics for fasting glucose and risk of chronic kidney disease in the total population, diabetic participants, and nondiabetic participants were 0.591, 0.624 and 0.541, respectively; and 0.521, 0.575, and 0.566, respectively, for ESRD.


Glycated hemoglobin and the risk of kidney disease and retinopathy in adults with and without diabetes.

Selvin E, Ning Y, Steffes MW, Bash LD, Klein R, Wong TY, Astor BC, Sharrett AR, Brancati FL, Coresh J - Diabetes (2010)

Adjusted HR of incident chronic kidney disease according to baseline glycated hemoglobin value. The figures show adjusted HRs from restricted cubic spline models. The shaded area is the 95% CI. The models are centered at the median (5.5%, 5.4%, and 7.4% in the total population, nondiabetic, and diabetic participants, respectively) and truncated at the 2.5th and the 97.5th percentiles of glycated hemoglobin in each population. The HRs were adjusted for age, sex, and race (black or white), low-density and high-density cholesterol levels, log transformed triglyceride level, BMI, waist-to-hip ratio, hypertension (yes or no), family history of diabetes (yes or no), education (less than high school, high school or equivalent, or college or above), alcohol use (currently, formerly, or never), physical activity index score, and smoking status (current smoker, former smoker, or never smoked). The model in A is further adjusted for diabetes medication use. The data are shown on a natural-log scale. (A high-quality color representation of this figure is available in the online issue.)
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3012185&req=5

Figure 2: Adjusted HR of incident chronic kidney disease according to baseline glycated hemoglobin value. The figures show adjusted HRs from restricted cubic spline models. The shaded area is the 95% CI. The models are centered at the median (5.5%, 5.4%, and 7.4% in the total population, nondiabetic, and diabetic participants, respectively) and truncated at the 2.5th and the 97.5th percentiles of glycated hemoglobin in each population. The HRs were adjusted for age, sex, and race (black or white), low-density and high-density cholesterol levels, log transformed triglyceride level, BMI, waist-to-hip ratio, hypertension (yes or no), family history of diabetes (yes or no), education (less than high school, high school or equivalent, or college or above), alcohol use (currently, formerly, or never), physical activity index score, and smoking status (current smoker, former smoker, or never smoked). The model in A is further adjusted for diabetes medication use. The data are shown on a natural-log scale. (A high-quality color representation of this figure is available in the online issue.)
Mentions: We observed significant trends of increasing risk of chronic kidney disease and ESRD with higher values of baseline glycated hemoglobin in individuals without a history of diabetes even after adjustment for known risk factors (Table 2). Among individuals without diabetes, clinical categories of glycated hemoglobin (<5.7, 5.7–<6.5, and ≥6.5%) were stronger predictors of chronic kidney disease and ESRD as compared with categories of fasting glucose (<100, 100–<126, and ≥126 mg/dl). Diabetes history was strongly associated with risk of chronic kidney disease and ESRD even after adjustment (Table 2). Figure 2 depicts the adjusted HRs from the restricted cubic spline models for chronic kidney disease by baseline glycated hemoglobin value in the total population and, separately, in nondiabetic and diabetic participants. The restricted cubic spline models for the association of fasting glucose are presented in supplementary Fig. 1 in the online appendix available at http://diabetes.diabetesjournals.org/cgi/content/full/db10-1198/DC1. The C statistics from the unadjusted Cox model for glycated hemoglobin (modeled continuously) and risk of chronic kidney disease in the total population, diabetic participants, and nondiabetic participants were 0.608, 0.644, and 0.562, respectively. The C statistics for ESRD were 0.760, 0.619, and 0.648, respectively. The C statistics for fasting glucose and risk of chronic kidney disease in the total population, diabetic participants, and nondiabetic participants were 0.591, 0.624 and 0.541, respectively; and 0.521, 0.575, and 0.566, respectively, for ESRD.

Bottom Line: During a median of 14 years of follow-up of individuals without diagnosed diabetes at baseline, clinical categories of glycated hemoglobin were associated with risk of chronic kidney disease, with adjusted hazard ratios (HRs) of 1.12 (0.94-1.34) and 1.39 (1.04-1.85) for glycated hemoglobin 5.7-6.4% and ≥6.5%, respectively, as compared with <5.7% (P trend = 0.002).In the absence of diagnosed diabetes, glycated hemoglobin was cross sectionally associated with the presence of moderate/severe retinopathy, with adjusted odds ratios of 1.42 (0.69-2.92) and 2.91 (1.19-7.11) for glycated hemoglobin 5.7-<6.5% and ≥6.5%, respectively, compared with <5.7% (P trend = 0.011).We did not observe significant thresholds in the associations of glycated hemoglobin with kidney disease risk or retinopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. lselvin@jhsph.edu

ABSTRACT

Objective: Glycated hemoglobin was recently recommended for use as a diagnostic test for diabetes. We examined the association between 2010 American Diabetes Association diagnostic cut points for glycated hemoglobin and microvascular outcomes (chronic kidney disease, end-stage renal disease [ESRD], and retinopathy) and formally tested for the presence of risk thresholds in the relationships of glycated hemoglobin with these outcomes.

Research design and methods: Prospective cohort and cross-sectional analyses of 11,357 participants (773 with a history of diagnosed diabetes) from the Atherosclerosis Risk in Communities (ARIC) Study.

Results: During a median of 14 years of follow-up of individuals without diagnosed diabetes at baseline, clinical categories of glycated hemoglobin were associated with risk of chronic kidney disease, with adjusted hazard ratios (HRs) of 1.12 (0.94-1.34) and 1.39 (1.04-1.85) for glycated hemoglobin 5.7-6.4% and ≥6.5%, respectively, as compared with <5.7% (P trend = 0.002). The corresponding HRs for ESRD were 1.51 (0.82-2.76) and 1.98 (0.83-4.73), respectively (P trend = 0.047). In the absence of diagnosed diabetes, glycated hemoglobin was cross sectionally associated with the presence of moderate/severe retinopathy, with adjusted odds ratios of 1.42 (0.69-2.92) and 2.91 (1.19-7.11) for glycated hemoglobin 5.7-<6.5% and ≥6.5%, respectively, compared with <5.7% (P trend = 0.011). Risk associations were stronger among individuals with a history of diabetes. We did not observe significant thresholds in the associations of glycated hemoglobin with kidney disease risk or retinopathy.

Conclusions: These data from a community-based, biracial population support the use of new 2010 American Diabetes Association glycated hemoglobin cut points for the diagnosis of diabetes.

Show MeSH
Related in: MedlinePlus