title: Fluctuation between fasting and 2-H postload glucose state is associated with chronic kidney disease in previously diagnosed type 2 diabetes patients with HbA1c ≥ 7%.
abstract: OBJECTIVE
  To investigate how the glucose variability between fasting and a 2-h postload glucose state (2-h postload plasma glucose [2hPG]-fasting plasma glucose [FPG]) is associated with chronic kidney disease (CKD) in middle-aged and elderly Chinese patients previously diagnosed with type 2 diabetes.
  
  
  METHODS
  This cross-sectional study included 1054 previously diagnosed type 2 diabetes patients who were 40 years of age and older. First, the subjects were divided into two groups based on a glycated hemoglobin (HbA1c) value of 7%. Each group was divided into two subgroups, with or without CKD. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). CKD was defined as eGFR<60 mL/min/1.73 m2. Multiple linear regression analysis was used to estimate the association between the 2hPG-FPG and eGFR. The 2hPG-FPG value was divided into four groups increasing in increments of 36 mg/dl (2.0 mmol/L): 0-72, 72-108, 108-144 and ≥144 mg/dl, based on the quartiles of patients with HbA1c levels ≥7%; then, binary logistic regression analysis was used to investigate the association between 2hPG-FPG and the risk of CKD.
  
  
  RESULTS
  In the patients with HbA1c levels ≥7%, the 2hPG-FPG was significantly associated with decreased eGFR and an increased risk of CKD independent of age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, smoking, and drinking, as well as fasting insulin, cholesterol, triglyceride, and HbA1c levels. The patients with 2hPG-FPG values ≥144 mg/dl showed an increased odds ratio (OR) of 2.640 (P = 0.033). Additionally, HbA1c was associated with an increased risk of CKD in patients with HbA1c values ≥7%.
  
  
  CONCLUSIONS
  The short-term glucose variability expressed by 2hPG-FPG is closely associated with decreased eGFR and an increased risk of CKD in patients with poor glycemic control (HbA1c≥7%).
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Song
authors.affiliation: China National Heavy Duty Truck Group Corporation Hospital, Jinan, Shandong, China.
authors.forename: Zeqiang
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Lukang Hospital of Jining, Jining, Shandong, China.
authors.forename: Weifang
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China.
authors.forename: Chengqiao
authors.initials: C
authors.lastname: Li
authors.affiliation: Shantui Community Health Center, Jining, Shandong, China.
authors.forename: Xiuping
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Xinguo
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liang
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Gong
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Meijian
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Yan
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Junpeng
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Lingshu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Tian
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Jidong
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Ruxing
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005215:Fasting / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin