Evaluation of Serum Glucose and Kidney Disease Progression Among Patients With Diabetes

Abstract

IMPORTANCE The appropriate target of glycemic control in diabetic kidney disease is unclear. OBJECTIVE To investigate optimal on-treatment glycemic levels associated with slowing of diabetic kidney disease progression. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using nationwide Korean cohorts from the National Health Information Database from 2005 to 2019. Included individuals were adults with diabetes using antihyperglycemic agents with and without chronic kidney disease (CKD) identified from participants aged 40 to 74 years in a nationwide health screening survey conducted from 2009 to 2010. Data were analyzed from October 2020 through March 2021. EXPOSURE On-treatment fasting blood glucose (FBG) level. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of doubling of serum creatinine, end-stage kidney disease, or death from CKD. RESULTS Among 183 049 adults with diabetes using antihyperglycemic agents (mean [SD] age, 61.7 [8.4] years; 99 110 [54.1%] men), there were 131 401 individuals with dipstick albuminuria or an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m 2 (mean [SD] age, 62.4 [8.3] years; 71 280 [54.2%] men) and 51 648 individuals with no CKD (mean [SD] age, 59.6 [8.4] years;27 830 [53.9%] men). During 9 years of follow-up, the primary outcome occurred among 13 802 individuals with CKD (10.5%) and 1421 individuals with no CKD (2.8%). On-treatment FBG level had a J-shaped hazard ratio (HR) curve for the primary outcome. Among patients with albuminuria, FBG levels of 126 mg/dL to less than 140 mg/dL (HR, 0.87; 95% CI, 0.81-0.94) and 140 mg/dL to less than 160 mg/dL (HR, 0.90; 95% CI, 0.84-0.96) were associated with decreased risk and levels of 160 mg/dL to less than 180 mg/dL were associated with increased risk (HR, 1.10; 95% CI, 1.03-1.18) compared with FBG levels of 110 mg/dL to less than 126 mg/dL. Among patients with decreased eGFR, FBG levels of 80 mg/dL to less than 100 mg/dL (HR, 1.30; 95% CI, 1.20-1.42) and levels of 160 mg/dL to less than 180 mg/dL (HR, 1.13; 95% CI, 1.04-1.23) were associated with increased risk of the primary outcome compared with FBG levels of 110 mg/dL to less than 126 mg/dL. Among patients with no CKD, FBG levels of 80 mg/dL to less than 100 mg/dL (HR, 1.29; 95% CI, 1.01-1.65) and levels of 126 mg/dL to less than 140 mg/dL (HR, 1.23; 95% CI, 1.03-1.47) were associated with increased risk compared with FBG levels of 110 mg/dL to less than 126 mg/dL. Among patients with no albuminuria at baseline, FBG levels of 140 mg/dL to less than 160 mg/dL (HR, 1.14; 95% CI, 1.09-1.20) were associated with increased risk of new-onset albuminuria, while levels of 100 mg/dL to less than 110 mg/dL were not associated with increased risk compared with FBG levels of 110 mg/dL to less than 126 mg/dL. For all-cause mortality, while FBG levels of 160 mg/dL to less than 180 mg/dL (HR, 1.20; 95% CI, 1.12-1.28) were associated with increased risk among patients with albuminuria, FBG (continued) Key Points Question What is the ...

Fasting Glucose Variability as a Risk Indicator for End-Stage Kidney Disease in Patients with Diabetes: A Nationwide Population-Based Study

“…On the other hand, a high risk for ESKD was observed in individuals whose baseline FG levels were <100mg/dL or ≥180 mg/dL. These findings were consistent with another nationwide cohort study of Koreans with diabetes using GLMs [31], suggesting that intensive glucose control might not necessarily diminish the progression of established diabetic kidney disease.…”

Personalised prediction of maintenance dialysis initiation in patients with chronic kidney disease stages 3–5: a multicentre study using the machine learning approach

“…Diabetic nephropathy is the leading cause of ESRD in adults 23 24. In patients with diabetic CKD, blood glucose levels are associated with poor outcomes such as serum creatinine doubling, ESRD and mortality, and intensive glycaemic control could reduce these risks 25–29. Additionally, several studies have demonstrated that certain levels of dyslipidaemia is independently associated with rapid renal progression, KRT, all-cause mortality and cardiovascular death in predialysis patients 30–33.…”

Albuminuria Screening in People With Type 2 Diabetes in a Managed Care Organization

“…Spain, 23 Norway, 24 and the United Kingdom 25 reported low levels of screening (≤32% screening). In smaller countries, with centralized medical delivery systems, for example, Denmark 26 and South Korea, 27 screening rates have reached ∼80% in the past few years. Regarding automated laboratory ordering, little information is available in the medical literature.…”