Su Bin Park1, Sang Soo Kim2, In Joo Kim3, Yoon Jeong Nam1, Kang Hee Ahn1, Jong Ho Kim2, Yun Kyung Jeon2, Bo Hyun Kim2, Sang Heon Song2, Ihm Soo Kwak2, Eun Kyung Lee4, Yong Ki Kim5. 1. Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea. 2. Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. 3. Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. Electronic address: injkim@pusan.ac.kr. 4. Endocare Pharmacy, Busan, Republic of Korea. 5. Kim Yong Ki Internal Medicine Clinic, Busan, Republic of Korea.
Abstract
AIM: The present study was performed to assess variability in glycated albumin (GA) using a coefficient of variation (CV) to predict the progression of diabetic nephropathy in type 2 diabetic patients, independently of HbA1c and other conventional risk factors. METHODS: The present study consecutively enrolled 369 patients with type 2 diabetes mellitus from outpatient clinic. During the follow-up period, GA and HbA1c levels were measured repeatedly (≥5 times), and the CV of GA (GA-CV) was calculated for each patient. The patients were divided into two subgroups: Group 1, a MEAN-HbA1c value <7.2% (55mmol/mol); Group 2, a MEAN-HbA1c value ≥7.2% (55mmol/mol). The primary outcome was the renal composite outcome (RCO), which was based on the progression rates of chronic kidney disease and albuminuria and renal death. RESULTS: The median follow-up period was 33months. The RCO was developed in 109 patients (29.5%). In Group 1, the third highest and highest quartile groups for GA-CV had higher cumulative incidences of the RCO than those of the lowest quartile group (Q4 vs. Q1: HR=5.43, P=0.007, Q3 vs. Q1: HR=5.16, P=0.009). After adjusting for HbA1c levels and other risk factors, the GA-CV remained significantly associated with the development of the RCO. However, Group 2 did not exhibit any significant differences in terms of the cumulative incidence of the RCO among the four GA-CV quartile groups. CONCLUSIONS: The present findings suggest that variability in GA may be a better predictor of the progression of diabetic nephropathy in type 2 diabetic patients regardless of HbA1c.
AIM: The present study was performed to assess variability in glycated albumin (GA) using a coefficient of variation (CV) to predict the progression of diabetic nephropathy in type 2 diabeticpatients, independently of HbA1c and other conventional risk factors. METHODS: The present study consecutively enrolled 369 patients with type 2 diabetes mellitus from outpatient clinic. During the follow-up period, GA and HbA1c levels were measured repeatedly (≥5 times), and the CV of GA (GA-CV) was calculated for each patient. The patients were divided into two subgroups: Group 1, a MEAN-HbA1c value <7.2% (55mmol/mol); Group 2, a MEAN-HbA1c value ≥7.2% (55mmol/mol). The primary outcome was the renal composite outcome (RCO), which was based on the progression rates of chronic kidney disease and albuminuria and renal death. RESULTS: The median follow-up period was 33months. The RCO was developed in 109 patients (29.5%). In Group 1, the third highest and highest quartile groups for GA-CV had higher cumulative incidences of the RCO than those of the lowest quartile group (Q4 vs. Q1: HR=5.43, P=0.007, Q3 vs. Q1: HR=5.16, P=0.009). After adjusting for HbA1c levels and other risk factors, the GA-CV remained significantly associated with the development of the RCO. However, Group 2 did not exhibit any significant differences in terms of the cumulative incidence of the RCO among the four GA-CV quartile groups. CONCLUSIONS: The present findings suggest that variability in GA may be a better predictor of the progression of diabetic nephropathy in type 2 diabeticpatients regardless of HbA1c.