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Fluctuation between fasting and 2-H postload glucose state is associated with glomerular hyperfiltration in newly diagnosed diabetes patients with HbA1c < 7%.

Hou X, Wang C, Wang S, Yang W, Ma Z, Wang Y, Li C, Li M, Zhang X, Zhao X, Sun Y, Song J, Lin P, Liang K, Gong L, Wang M, Liu F, Li W, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Chen S, Chen L - PLoS ONE (2014)

Bottom Line: GHF was defined as an eGFR ≥ the 90th percentile.Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and ≥ 108 mg/dl.Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.

ABSTRACT

Objective: To investigate whether fluctuations between the fasting and 2-h postload glucose ([2-hPBG]-fasting blood glucose [FBG]) states are associated with glomerular hyperfiltration (GHF) in middle-aged and elderly Chinese patients with newly diagnosed diabetes.

Design and methods: In this study, we included 679 newly diagnosed diabetes patients who were ≥ 40 years old. All the subjects were divided into two groups; those with HbA1c<7% and ≥ 7%. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). GHF was defined as an eGFR ≥ the 90th percentile. First, a multiple linear regression analysis was used to estimate the association of 2-hPBG-FBG with eGFR. Then, a generalized additive model was used to explore the possible nonlinear relationship between 2-hPBG-FBG and eGFR. Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and ≥ 108 mg/dl. Finally, a multiple logistic regression analysis was used to investigate the association of 2-hPBG-FBG with the risk of GHF.

Results: For the group with HbA1c<7%, the eGFR and the percentage of GHF were significantly higher compared with the group with HbA1c ≥ 7%. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and glycated hemoglobin (HbA1c), 2-hPBG-FBG was significantly associated with increased eGFR and an increased risk of GHF (the GHF risk increased by 64.9% for every 36.0 mg/dl [2.0 mmol/L] 2-hPBG-FBG increase) only in those patients with HbA1c<7%. Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).

Conclusions: Increased fluctuations between the fasting and 2-h postload glucose states are closely associated with increased eGFR and an increased risk of GHF in newly diagnosed diabetes patients with HbA1c<7%.

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Nonlinear association of the difference between 2-h postload blood glucose and fasting blood glucose (2-hPBG-FBG) in association with estimated glomerular filtration rate (eGFR).The association was analyzed in a generalized additive model (df = 3, P<0.001) adjusted for age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c.
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pone-0111173-g001: Nonlinear association of the difference between 2-h postload blood glucose and fasting blood glucose (2-hPBG-FBG) in association with estimated glomerular filtration rate (eGFR).The association was analyzed in a generalized additive model (df = 3, P<0.001) adjusted for age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c.

Mentions: As shown in Table 2, we constructed three models to analyze the association of 2-hPBG-FBG with eGFR (the calculation of HOMA-IR and 2-hPBG-FBG both involved FBG, so we adjusted for fasting insulin rather than for HOMA-IR in model 3). The linearity of the relationship was assessed using a histogram of the residuals for each model together with a scatterplot of the standardized residuals versus the standardized predicted values, which indicated an approximately linear relationship. Interestingly, a significantly positive association of 2-hPBG-FBG with eGFR was observed in all three models for the newly diagnosed diabetes patients with HbA1c<7% only, which was independent of age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c. Moreover, we found a nonlinear association of 2-hPBG-FBG and eGFR using a generalized additive model after multivariable adjustment (P<0.001; Fig. 1). In contrast, a negative relationship between HbA1c and eGFR was observed in the patients with HbA1c (%) ≥7.


Fluctuation between fasting and 2-H postload glucose state is associated with glomerular hyperfiltration in newly diagnosed diabetes patients with HbA1c < 7%.

Hou X, Wang C, Wang S, Yang W, Ma Z, Wang Y, Li C, Li M, Zhang X, Zhao X, Sun Y, Song J, Lin P, Liang K, Gong L, Wang M, Liu F, Li W, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Chen S, Chen L - PLoS ONE (2014)

Nonlinear association of the difference between 2-h postload blood glucose and fasting blood glucose (2-hPBG-FBG) in association with estimated glomerular filtration rate (eGFR).The association was analyzed in a generalized additive model (df = 3, P<0.001) adjusted for age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216006&req=5

pone-0111173-g001: Nonlinear association of the difference between 2-h postload blood glucose and fasting blood glucose (2-hPBG-FBG) in association with estimated glomerular filtration rate (eGFR).The association was analyzed in a generalized additive model (df = 3, P<0.001) adjusted for age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c.
Mentions: As shown in Table 2, we constructed three models to analyze the association of 2-hPBG-FBG with eGFR (the calculation of HOMA-IR and 2-hPBG-FBG both involved FBG, so we adjusted for fasting insulin rather than for HOMA-IR in model 3). The linearity of the relationship was assessed using a histogram of the residuals for each model together with a scatterplot of the standardized residuals versus the standardized predicted values, which indicated an approximately linear relationship. Interestingly, a significantly positive association of 2-hPBG-FBG with eGFR was observed in all three models for the newly diagnosed diabetes patients with HbA1c<7% only, which was independent of age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c. Moreover, we found a nonlinear association of 2-hPBG-FBG and eGFR using a generalized additive model after multivariable adjustment (P<0.001; Fig. 1). In contrast, a negative relationship between HbA1c and eGFR was observed in the patients with HbA1c (%) ≥7.

Bottom Line: GHF was defined as an eGFR ≥ the 90th percentile.Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and ≥ 108 mg/dl.Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.

ABSTRACT

Objective: To investigate whether fluctuations between the fasting and 2-h postload glucose ([2-hPBG]-fasting blood glucose [FBG]) states are associated with glomerular hyperfiltration (GHF) in middle-aged and elderly Chinese patients with newly diagnosed diabetes.

Design and methods: In this study, we included 679 newly diagnosed diabetes patients who were ≥ 40 years old. All the subjects were divided into two groups; those with HbA1c<7% and ≥ 7%. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). GHF was defined as an eGFR ≥ the 90th percentile. First, a multiple linear regression analysis was used to estimate the association of 2-hPBG-FBG with eGFR. Then, a generalized additive model was used to explore the possible nonlinear relationship between 2-hPBG-FBG and eGFR. Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and ≥ 108 mg/dl. Finally, a multiple logistic regression analysis was used to investigate the association of 2-hPBG-FBG with the risk of GHF.

Results: For the group with HbA1c<7%, the eGFR and the percentage of GHF were significantly higher compared with the group with HbA1c ≥ 7%. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and glycated hemoglobin (HbA1c), 2-hPBG-FBG was significantly associated with increased eGFR and an increased risk of GHF (the GHF risk increased by 64.9% for every 36.0 mg/dl [2.0 mmol/L] 2-hPBG-FBG increase) only in those patients with HbA1c<7%. Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).

Conclusions: Increased fluctuations between the fasting and 2-h postload glucose states are closely associated with increased eGFR and an increased risk of GHF in newly diagnosed diabetes patients with HbA1c<7%.

Show MeSH
Related in: MedlinePlus