Impact of haemoglobin A1c trajectories on chronic kidney disease progression in type 2 diabetes

• Published in: Nephrology (Carlton, Vic.) Vic.), 2019-10, Vol.24 (10), p.1026-1032
• Main Authors: Low, Serena, Zhang, Xiao, Wang, Jiexun, Yeoh, Lee Y, Liu, Yan L, Ang, Su F, Subramaniam, Tavintharan, Sum, Chee F, Lim, Su C
• Format: Article
• Language: English
• Subjects: chronic kidney disease; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Nephropathies - blood; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - etiology; Disease Progression; Female; Glomerular filtration rate; Glycated Hemoglobin A - analysis; haemoglobin A1c trajectory; Health risk assessment; Hemoglobin; Humans; Kidney diseases; Kidney Function Tests - methods; Kidney Function Tests - statistics & numerical data; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - etiology; Risk Factors; Singapore - epidemiology; type 2 diabetes mellitus
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13533

ABSTRACT Aim To characterize haemoglobin A1c (HbA1c) trajectories and examine their associations with chronic kidney disease (CKD) progression. Methods This was a prospective cohort study on 770 patients with type 2 diabetes mellitus (T2DM) attending a diabetes centre in 2002–2017. Group‐based trajectory modelling was used to identify HbA1c trajectories. Cox proportional hazards models were used to examine association between the trajectories and CKD progression which was defined as deterioration across the Kidney Disease: Improving Global Outcomes estimated glomerular filtration rate categories with ≥25% drop from baseline. Results We identified four HbA1c trajectories: ‘near‐optimal stable’ (49.1%), ‘moderate stable’ (37.9%), ‘moderate‐increasing’ (6.0%) and ‘high‐decreasing’ (7.0%). Over a median follow‐up period of 4.6 years (interquartile range 2.5–5.6), CKD progression occurred in 35.6% of patients. The risk of CKD progression was significantly higher in the moderate‐increasing with adjusted hazard ratios (HR) 2.23 (95% confidence interval (CI) 1.09–4.57). After additional adjustment for mean HbA1c, the association between the moderate‐increasing subgroup and CKD progression remained significant at HR 3.07 (95% CI 1.08–8.77). Conclusion Moderate‐increasing HbA1c trajectory is associated with renal disease progression in patients with T2DM, independent of mean HbA1c. The deleterious effects of deteriorating HbA1c trajectory highlight the importance of achieving sustained good glycaemic control in diabetes management. SUMMARY AT A GLANCE This paper demonstrates that a moderate‐increasing haemoglobin A1c (HbA1c) trajectory (defined as initially moderate glycaemic control with mean HbA1c at 8.4% during the first year but subsequently worsened during follow‐up) is associated with renal disease progression in type 2 diabetes mellitus patients. The findings support the importance of sustained glycaemic control to reduce microvascular renal disease.