Prevalence of moderately increased albuminuria among individuals with normal HbA1c level but impaired glucose tolerance: Results from the LIFE‐Adult‐Study

Abstract

Summary Aims Diabetes screening strategies using glycated haemoglobin (HbA1c) as first‐instance diagnostic parameter may cause failure to detect individuals with abnormal glucose regulation and possible signs of microvascular complications despite “rule‐out” HbA1c levels. This cross‐sectional study examined the diagnostic performance of HbA1c in relation to fasting and two‐hour postload plasma glucose (FPG/2 h‐PG), and investigated whether individuals with normal HbA1c but abnormal FPG/2 h‐PG have a higher prevalence of moderately increased albuminuria as possible sign of early stage kidney damage. Methods A total of 2695 individuals (age 40‐79 years, 48% men) without prior diagnosis of diabetes and complete measurement of HbA1c, FPG, 2 h‐PG and urine albumin‐creatinine ratio (UACR) were taken from a large population‐based epidemiological study in the City of Leipzig, Germany. Results A total of 2439 individuals (90.5%, 95% CI: 89.4‐91.6) had normal HbA1c levels, <39 mmol/mol (<5.7%), while 234 (8.7%, 95% CI: 7.7‐9.8) had prediabetes, HbA1c ≥39 and <48 mmol/mol (≥5.7 and <6.5%), and 22 (0.8%, 95% CI: 0.5‐1.2) had diabetes, HbA1c ≥48 mmol/mol (≥6.5%), according to HbA1c. Among individuals with normal HbA1c, 35.6% (95% CI: 33.7‐37.5) had impaired fasting glucose or impaired glucose tolerance and 1.8% (95% CI: 1.4‐2.4) had diabetes according to FPG/2 h‐PG. Individuals with normal HbA1c but prediabetic or diabetic FPG/2 h‐PG had a significantly higher prevalence of moderately increased albuminuria (9.4%, 95% CI: 7.6‐11.5 and 13.3%, 95% CI: 5.8‐25.4, respectively) than individuals with normal HbA1c and normal FPG/2 h‐PG (3.9%, 95% CI: 3.0‐5.0). Conclusions The prevalence of prediabetes according to FPG/2 h‐PG among individuals with normal HbA1c is considerably high, and the prevalence of moderately increased albuminuria in this group is significantly elevated. Risk factors for diabetes such as age, gender and BMI may help to better identify this at‐risk group.

Non-medicalization of medical science: Rationalization for future

“…In a meta-analysis done by Echouffo-Tcheugui et al [ 48 ], pre-diabetes was associated with a moderately increased risk of CKD. Several studies have shown similar results with increased rates of micro-albuminuria and progression to chronic kidney disease in prediabetes[ 49 - 51 ]. Pre-diabetes also has been associated with an increased prevalence of diabetic neuropathy, especially autonomic involvement, and increased risk of diabetic retinopathy[ 52 , 53 ].…”

Low-grade albuminuria in adult and elderly individuals with diabetes mellitus and arterial hypertension accompanied by Primary Health Care

“…It is worth mentioning the divergence between the sample populations of the studies, as well as the observation of a possible collinearity between the variables HbA1c and FPG in the present study, since, despite being different biochemical tests, both measure the presence of glucose in the blood. Another study finds that the prevalence of prediabetes according to FPG/2 h-PG among individuals with normal HbA1c is considerably high, and the prevalence of moderately increased albuminuria in this group is significantly elevated 19 .…”

Prediabetes Deserves More Attention: A Review

“…Kim et al (35), Tsuda et al (36), and Živković et al (37) demonstrated increased glomerular hydrostatic pressure and albuminuria in people with IFG, IGT, and/or prediabetes by the ADA A1C criterion even after adjusting for age, sex, obesity, hypertension, metabolic syndrome, and other risk factors for chronic kidney disease (CKD). Similarly, a systematic review and meta-analysis by Echouffo-Tcheugui et al (38) showed that prediabetes is modestly associated with an increased risk of CKD.…”