title: Fluctuation between fasting and 2-H postload glucose state is associated with glomerular hyperfiltration in newly diagnosed diabetes patients with HbA1c < 7%.
abstract: OBJECTIVE
  To investigate whether fluctuations between the fasting and 2-h postload glucose ([2-hPBG]-fasting blood glucose [FBG]) states are associated with glomerular hyperfiltration (GHF) in middle-aged and elderly Chinese patients with newly diagnosed diabetes.
  
  
  METHODS
  In this study, we included 679 newly diagnosed diabetes patients who were ≥ 40 years old. All the subjects were divided into two groups; those with HbA1c<7% and ≥ 7%. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). GHF was defined as an eGFR ≥ the 90th percentile. First, a multiple linear regression analysis was used to estimate the association of 2-hPBG-FBG with eGFR. Then, a generalized additive model was used to explore the possible nonlinear relationship between 2-hPBG-FBG and eGFR. Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and ≥ 108 mg/dl. Finally, a multiple logistic regression analysis was used to investigate the association of 2-hPBG-FBG with the risk of GHF.
  
  
  RESULTS
  For the group with HbA1c<7%, the eGFR and the percentage of GHF were significantly higher compared with the group with HbA1c ≥ 7%. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and glycated hemoglobin (HbA1c), 2-hPBG-FBG was significantly associated with increased eGFR and an increased risk of GHF (the GHF risk increased by 64.9% for every 36.0 mg/dl [2.0 mmol/L] 2-hPBG-FBG increase) only in those patients with HbA1c<7%. Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).
  
  
  CONCLUSIONS
  Increased fluctuations between the fasting and 2-h postload glucose states are closely associated with increased eGFR and an increased risk of GHF in newly diagnosed diabetes patients with HbA1c<7%.
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Xinguo
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Lukang Hospital of Jining, Jining, Shandong, China.
authors.forename: Shaoyuan
authors.initials: S
authors.lastname: Wang
authors.affiliation: Lukang Hospital of Jining, Jining, Shandong, China.
authors.forename: Weifang
authors.initials: W
authors.lastname: Yang
authors.affiliation: China National Heavy Duty Truck Group Corporation Hospital, Jinan, Shandong, China.
authors.forename: Zeqiang
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China.
authors.forename: Yulian
authors.initials: Y
authors.lastname: Wang
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: Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Li
authors.affiliation: Shantui Community Health Center, Jining, Shandong, China.
authors.forename: Xiuping
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Shantui Community Health Center, Jining, Shandong, China.
authors.forename: Xiangmin
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liang
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Gong
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Meijian
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Yan
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Junpeng
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Lingshu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Tian
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Jidong
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Ruxing
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology, the Second Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Shihong
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D005215:Fasting; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin