Risks of rapid decline renal function in patients with type 2 diabetes

Chubb

European Journal of Endocrinology

2016

Objective: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. Design: Longitudinal observational study. Methods: Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. Results: In the full cohort (1296 patients; mean ± s.d. age 64.1 ± 11.3 years, 48.6% males), 738 (56.9%) died during 12.9 ± 6.1 years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59 mL/min/1.73 m 2 ) as reference, the strongest association was for eGFR ≥90 mL/min/1.73 m 2 (hazard ratio (95% CI) 2.01 (1.52-2.66); P < 0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P ≤ 0.003) and associated median reductions in survival of 6.5 and 8.7 years respectively. Conclusion: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.

mentioning

confidence: 99%

The relationship between estimated glomerular filtration rate trajectory and all-cause mortality in type 2 diabetes: the Fremantle Diabetes Study

Chubb

European Journal of Endocrinology

2016

“…The small changes in these renal parameters are consistent with progression of renal disease that might be anticipated in the study population. 21 Thus, there were no findings to suggest that omarigliptin treatment increases the risk of worsening renal dysfunction in this study population with RI.…”

Section: Discussionmentioning

confidence: 45%

A randomised, double-blind, trial of the safety and efficacy of omarigliptin (a once-weekly DPP-4 inhibitor) in subjects with type 2 diabetes and renal impairment

et al. 2017

SummaryAims: To assess the safety and efficacy of omarigliptin in subjects with type 2 diabetes mellitus (T2DM) and chronic renal impairment (RI). Methods:Patients with T2DM with moderate RI (estimated glomerular filtration rate[eGFR] ≥30 to <60 mL/min/1.73 m 2 ) (N=114), severe RI (eGFR <30 mL/min/1.73 m 2 ) (N=55) or end-stage renal disease on dialysis (N=44), who were either not on an antihyperglycaemic agent therapy for at least 12 weeks at screening, washed-off of oral antihyperglycaemic agent monotherapy or low-dose dual combination therapy, or on insulin monotherapy, with baseline glycated haemoglobin (HbA1c) of 6.5%-10.0% were randomised to omarigliptin or to placebo for 24 weeks (primary end-point) followed by a 30-week period with subjects on placebo switched to blinded glipizide (if not on insulin).Results: After 24 weeks, from a mean baseline HbA1c of 8.4% in the omarigliptin group and 8.3% in the placebo group, the least squares mean (95% CI) change from baseline in HbA1c in the overall population (all renal strata combined) was −0.77% (−1.00 to −0.54) in the omarigliptin group and −0.44% (−0.67 to −0.21) in the placebo group; between-group difference of −0.33% (−0.63 to −0.02); P=0.035. After 24 weeks, the incidences of subjects with symptomatic hypoglycaemia, one or more adverse event (AE), drug-related AE, serious AE and discontinuation due to an AE were similar in the omarigliptin and placebo groups. Conclusions:In this study in subjects with T2DM and RI, relative to placebo, omarigliptin provided clinically meaningful reductions in HbA1c, had a similar incidence of symptomatic hypoglycaemia and was generally well tolerated.

“…[28] Zhou et al [29] recorded lower Vitamin D deficiency has recently been gaining acceptance as a risk factor for a decline in renal function in DM patients. [30] Furthermore, a meta-analysis demonstrated that vitamin D can ameliorate proteinuria and protect kidneys from injury in DM patients, independently from blood pressure and glucose reduction. [31] In light of these data, we looked for an association between vitamin D insufficiency and DN, but our results did not suggest this relationship with either microalbuminuria or macroalbuminuria.…”

Section: Discussionmentioning

confidence: 99%

Is There a Relation Between Serum Vitamin D Level and Microvascular Comlications in Type 2 Diabetes?

Böyük

2017

EJMO

V itamin D is absorbed into the body through exposure to sunlight, a diet of vitamin-fortified foods, and dietary supplements. The major source of vitamin D absorption is through skin synthesis. Vitamin D receptors have been found in various tissues, including the brain, prostate, breast, colon, pancreas, and immune cells.[1] The estimated worldwide prevalence of vitamin D (25-hydroxyvitamin D [25(OH) D]) deficiency is 30% to 87%.[2] A study in Turkey in 2000 demonstrated that the deficiency prevalence ranged between 44% and 100% in women.[3] Furthermore, studies have revealed a high prevalence of vitamin D deficiency in type 2 diabetes mellitus (T2DM) patients in the Turkish population. [4,5] Recently, vitamin D was found to have various effects on glucose metabolism, obesity, metabolic syndrome, cardiovascular diseases, and cancer, as well as bone metabolism. It has been suggested that vitamin D is involved in insulin sensitivity by controlling calcium flux through the membrane in both beta-cells and peripheral Objectives:The aim of this study was to further investigate the prevalence of Vitamin D deficiency in diabetes mellitus (DM) patients, as well as the association between hypovitaminosis D and the microvascular complications of type 2 (T2) DM. Methods: This was a cross-sectional, case-control study of 206 T2DM patients and 34 healthy control subjects. Participants were evaluated for the presence of diabetic retinopathy, nephropathy, and neuropathy. Results: The level of serum 25-hydroxyvitamin D (25(OH) D) was significantly lower in the T2DM patients (11.16±3.99 ng/mL vs. 15.58±3.16 ng/mL; p<0.05). Furthermore, 2.7% of the patients were found to have retinopathy (n=53), 3.6% had neuropathy (n=65), and 29.1% of the patients had microalbuminuria (n=60). Although serum 25(OH) D levels were significantly lower in the presence of retinopathy and neuropathy (p<0.05 for both), no significant association between Vitamin D level and microalbuminuria was found. Conclusion: An inverse relationship between the circulating 25(OH) D level and the prevalence of retinopathy and neuropathy in T2DM patients was determined. However, there was no significant association between microalbuminuria and the 25(OH) D level.