Limits...
Extreme Levels of HbA1c Increase Incident ESRD Risk in Chinese Patients with Type 2 Diabetes: Competing Risk Analysis in National Cohort of Taiwan Diabetes Study.

Liao LN, Li CI, Liu CS, Huang CC, Lin WY, Chiang JH, Lin CC, Li TC - PLoS ONE (2015)

Bottom Line: Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia.Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population.Clinicians need to pay attention to HbA1c results on diabetic nephropathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.

ABSTRACT

Background: Whether HbA1c is a predictor of end-stage renal disease (ESRD) in type 2 diabetes patients remains unclear. This study evaluated relationship between HbA1c and ESRD in Chinese patients with type 2 diabetes.

Methods: Patients aged ≥ 30 years who were free of ESRD (n = 51 681) were included from National Diabetes Care Management Program from 2002-2003. Extended Cox proportional hazard model with competing risk of death served to evaluate association between HbA1c level and ESRD.

Results: A total of 2613 (5.06%) people developed ESRD during a follow-up period of 8.1 years. Overall incidence rate of ESRD was 6.26 per 1000 person-years. Patients with high levels of HbA1c had a high incidence rate of ESRD, from 4.29 for HbA1c of  6.0%-6.9% to 10.33 for HbA1c ≥ 10.0% per 1000 person-years. Patients with HbA1c < 6.0% particularly had a slightly higher ESRD incidence (4.34 per 1000 person-years) than those with HbA1c  of 6.0%-6.9%. A J-shaped relationship between HbA1c level and ESRD risk was observed. After adjustment, patients with HbA1c < 6.0% and ≥ 10.0% exhibited an increased risk of ESRD (HR: 1.99, 95% CI: 1.62-2.44; HR: 4.42, 95% CI: 3.80-5.14, respectively) compared with those with HbA1c of 6.0%-6.9%.

Conclusions: Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia. Our study revealed that HbA1c level ≥ 7.0% was linked with increased ESRD risk in type 2 diabetes patients, and that HbA1c < 6.0% also had the potential to increase ESRD risk. Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population. Clinicians need to pay attention to HbA1c results on diabetic nephropathy.

No MeSH data available.


Related in: MedlinePlus

Cumulative incidence curves of ESRD according to clinical criteria of HbA1c levels.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4476774&req=5

pone.0130828.g001: Cumulative incidence curves of ESRD according to clinical criteria of HbA1c levels.

Mentions: Table 2 shows the IDRs of ESRD according to HbA1c levels, HRs of ESRD, and their 95% CIs. Patients with high levels of baseline HbA1c had high IDRs of ESRD, from 4.34 for HbA1c < 6.0% to 10.33 for HbA1c≥10.0% per 1000 person-years. A J-shaped relationship between HbA1c and incident ESRD risk was observed. Patients with HbA1c < 6.0% and≥10.0% were at a 1.99- and 4.42-fold greater risk of ESRD (95% CI: 1.62–2.44, P < .001 and 95% CI: 3.80–5.14, P < .001, respectively) than were patients with HbA1c levels of 6.0%–6.9% after considering age, sex, diabetes duration, lifestyle behaviors, eGFR, medications, and comorbidities. In a sensitivity analysis, we observed similar results after excluding patients with DKA, HHNK, severe hypoglycemia, CVA, CAD, and CHF; the adjusted HRs and their 95% CIs were 2.26 (1.76–2.92), 1.94 (1.59–2.37), 2.33 (1.90–2.85), 2.98 (2.42–3.66), and 4.99 (4.15–6.01) in HbA1c < 6.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and≥10.0%, respectively, compared with that in HbA1c 6.0%–6.9%. Furthermore, to reduce the random error of one HbA1c measurement, we used the mean value of HbA1c measurements obtained within 1 year as the predictor of ESRD risk (n  =  31 747). We also observed a J-shaped relationship between HbA1c and ESRD risk; that is, the adjusted HRs and their 95% CIs were 2.20 (1.70–2.85), 1.80 (1.47–2.19), 2.10 (1.72–2.56), 2.66 (2.16–3.29), and 4.32 (3.53–5.28) in HbA1c < 6.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and≥10.0%, respectively, compared with that in HbA1c 6.0%–6.9%. Fig 1 presents the cumulative incidence curves of ESRD based on HbA1c levels. Patients with baseline HbA1c≥10.0% were at an increased risk of ESRD (log-rank test P < .0001).


Extreme Levels of HbA1c Increase Incident ESRD Risk in Chinese Patients with Type 2 Diabetes: Competing Risk Analysis in National Cohort of Taiwan Diabetes Study.

Liao LN, Li CI, Liu CS, Huang CC, Lin WY, Chiang JH, Lin CC, Li TC - PLoS ONE (2015)

Cumulative incidence curves of ESRD according to clinical criteria of HbA1c levels.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476774&req=5

pone.0130828.g001: Cumulative incidence curves of ESRD according to clinical criteria of HbA1c levels.
Mentions: Table 2 shows the IDRs of ESRD according to HbA1c levels, HRs of ESRD, and their 95% CIs. Patients with high levels of baseline HbA1c had high IDRs of ESRD, from 4.34 for HbA1c < 6.0% to 10.33 for HbA1c≥10.0% per 1000 person-years. A J-shaped relationship between HbA1c and incident ESRD risk was observed. Patients with HbA1c < 6.0% and≥10.0% were at a 1.99- and 4.42-fold greater risk of ESRD (95% CI: 1.62–2.44, P < .001 and 95% CI: 3.80–5.14, P < .001, respectively) than were patients with HbA1c levels of 6.0%–6.9% after considering age, sex, diabetes duration, lifestyle behaviors, eGFR, medications, and comorbidities. In a sensitivity analysis, we observed similar results after excluding patients with DKA, HHNK, severe hypoglycemia, CVA, CAD, and CHF; the adjusted HRs and their 95% CIs were 2.26 (1.76–2.92), 1.94 (1.59–2.37), 2.33 (1.90–2.85), 2.98 (2.42–3.66), and 4.99 (4.15–6.01) in HbA1c < 6.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and≥10.0%, respectively, compared with that in HbA1c 6.0%–6.9%. Furthermore, to reduce the random error of one HbA1c measurement, we used the mean value of HbA1c measurements obtained within 1 year as the predictor of ESRD risk (n  =  31 747). We also observed a J-shaped relationship between HbA1c and ESRD risk; that is, the adjusted HRs and their 95% CIs were 2.20 (1.70–2.85), 1.80 (1.47–2.19), 2.10 (1.72–2.56), 2.66 (2.16–3.29), and 4.32 (3.53–5.28) in HbA1c < 6.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and≥10.0%, respectively, compared with that in HbA1c 6.0%–6.9%. Fig 1 presents the cumulative incidence curves of ESRD based on HbA1c levels. Patients with baseline HbA1c≥10.0% were at an increased risk of ESRD (log-rank test P < .0001).

Bottom Line: Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia.Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population.Clinicians need to pay attention to HbA1c results on diabetic nephropathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.

ABSTRACT

Background: Whether HbA1c is a predictor of end-stage renal disease (ESRD) in type 2 diabetes patients remains unclear. This study evaluated relationship between HbA1c and ESRD in Chinese patients with type 2 diabetes.

Methods: Patients aged ≥ 30 years who were free of ESRD (n = 51 681) were included from National Diabetes Care Management Program from 2002-2003. Extended Cox proportional hazard model with competing risk of death served to evaluate association between HbA1c level and ESRD.

Results: A total of 2613 (5.06%) people developed ESRD during a follow-up period of 8.1 years. Overall incidence rate of ESRD was 6.26 per 1000 person-years. Patients with high levels of HbA1c had a high incidence rate of ESRD, from 4.29 for HbA1c of  6.0%-6.9% to 10.33 for HbA1c ≥ 10.0% per 1000 person-years. Patients with HbA1c < 6.0% particularly had a slightly higher ESRD incidence (4.34 per 1000 person-years) than those with HbA1c  of 6.0%-6.9%. A J-shaped relationship between HbA1c level and ESRD risk was observed. After adjustment, patients with HbA1c < 6.0% and ≥ 10.0% exhibited an increased risk of ESRD (HR: 1.99, 95% CI: 1.62-2.44; HR: 4.42, 95% CI: 3.80-5.14, respectively) compared with those with HbA1c of 6.0%-6.9%.

Conclusions: Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia. Our study revealed that HbA1c level ≥ 7.0% was linked with increased ESRD risk in type 2 diabetes patients, and that HbA1c < 6.0% also had the potential to increase ESRD risk. Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population. Clinicians need to pay attention to HbA1c results on diabetic nephropathy.

No MeSH data available.


Related in: MedlinePlus