Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease

Abstract

BackgroundMaintaining tight glycemic control is important for prevention of diabetes-related outcomes in end-stage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease.MethodsUsing data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) >7 vs. ≤7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011.ResultsOf 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients <40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c >7.5 % and >8 %.ConclusionIn this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.

Clinical characteristics and determinants of glycaemic control among type 2 diabetes mellitus (T2DM) patients in Fiji

“…Total cholesterol in this study was found to be signi cantly correlated with poor glycaemic control where T2DM patients with poorly controlled cholesterol level were 4 times higher chances of having poor glycaemic control compared to those with good control. This is similar to the ndings of other studies that higher total cholesterol concentration is an independent predictor of poor glycaemic control [38,40].…”

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

“…This finding is consistent with previous reports. Hypoalbuminemia is associated with poor glycemic control in HD patients with DM [36]. And while hypoalbuminemia is more frequently observed among patients with vs. without DM [37], it does not appear to differ between patients with diabetic kidney disease compared to patients with DM as a comorbidity whose renal disease is due to another underlying condition [38].…”

Prayer sign as a marker of increased ventilatory hours, length of intensive care unit and hospital stay in patients undergoing coronary artery bypass grafting surgery

“…It is well known that HbA1c, which reflects long-term glycemic control, is related to diabetic morbidity and mortality. [ 12 ] It has also been suggested that HbA1c can be used as a surrogate marker for cardiac and noncardiac morbidity that prolongs hospitalization after coronary artery bypass surgery. [ 4 ]…”