Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Abstract

Objective. Tight glycemic control reduces the risk of diabetes complications, but it may increase the risk of hypoglycemia or mortality in elderly patients. This study is aimed at evaluating the incidence and progression of renal complications and its association with glycemic control in elderly patients with type 2 diabetes. Methods. This retrospective cohort study examined the data of 3099 patients with type 2 diabetes who were followed for at least 10 years at the Korean Veterans Hospital and for whom glycated hemoglobin (HbA1c) was measured in 2008 and 2017. Participants were divided into six groups according to their baseline or dynamic HbA1c levels. Extended Cox models were used to calculate adjusted hazard ratios for the development of chronic kidney disease (CKD) and end-stage renal disease (ESRD) associated with specific HbA1c ranges. Results. During the 10-year follow-up period, 30% of patients developed new CKD, 50% showed progression, and ESRD developed in 1.7%. The risk of CKD was associated with baseline HbA1c from the first year of the study and dynamic HbA1c throughout the study period. The adjusted hazard ratios for CKD were 1.98 and 2.32 for baseline and dynamic HbA1c, respectively, at the level of ≥69 mmol/mol. There was no increased risk for any complications in baseline and dynamic HbA1c below 58 mmol/mol. Conclusions. A higher HbA1c≥58 mmol/mol was associated with an increased risk of diabetes complications. A less stringent glycemic target of HbA1c could be used as the threshold of renal complications.

Sugar-Sweetened Coffee Intake and Blood Glucose Management in Korean Patients with Diabetes Mellitus

“…Improper management of blood glucose level can also cause various complications in patients with DM. A cohort study of 3099 Korean outpatients with DM at the Veteran Health Service Medical Center from 2008 to 2017 showed an increased risk of chronic kidney disease and end-stage renal disease among outpatients with ≥8.5% HbA1c levels than those <6.5% HbA1c levels [56]. In addition, other studies have reported that improper glucose level management or prolonged disease duration due to poor management may be associated with cardiovascular diseases, sexual dysfunction, reduced total gray matter volume, dementia, and gastrointestinal diseases such as dyspepsia [51,[57][58][59][60][61][62].…”

Identification of genetic variants associated with diabetic kidney disease in multiple Korean cohorts via a genome-wide association study mega-analysis

“…1 ). In the previously constructed VHSMC cohort, diagnosed with type 2 DM by VHSMC endocrinologists [ 28 , 29 ], those who met the inclusion criteria ( n = 916) were enrolled in this study. The KoGES consortium is a nationwide cohort representative of genome research in Korea [ 30 ], of which three cohorts related to population-based studies [Korean Association Resource from Ansan and Ansung (KARE, n = 8840) cohort, KoGES Health Examinees (HEXA, n = 61,568) cohort, and KoGES cardiovascular disease association study (CAVAS, n = 9,715) cohort] were enrolled in this study.…”

“…There is a need for GWAS on DKD in large-scale Korean multi-cohorts. As reported in previous studies by the Veterans Health Service Medical Center (VHSMC) [ 28 , 29 ], several elderly veterans are diagnosed with DKD due to the extended duration of type 2 DM. Consequently, studies on DKD in Korean multi-cohorts would be helpful.…”

Relationship between daytime napping with the occurrence and development of diabetes: a systematic review and meta-analysis

“…Diabetes mellitus is one of the most common chronic diseases globally, with the prevalence increasing annually 1. Poor glycaemic control in people with diabetes may result in various acute and chronic complications, further aggravating disease progression 2 3. The glycaemic control status can be reflected by glycosylated haemoglobin and blood glucose levels in different states (eg, such as fasting blood glucose levels).…”