Glycemic control according to glomerular filtration rate in patients with type 2 diabetes and overt nephropathy: a prospective observational study.
OBJECTIVE
Type 2 diabetes (T2D) and chronic kidney disease (CKD) are closely linked. This study aimed to describe and analyze the relations between renal function and glycemic control in T2D patients with overt nephropathy.


METHODS
Data were collected from a French observational prospective multicenter study. Patients included were adults with T2D, clinical proteinuria and an estimated glomerular filtration rate (eGFR) over 15 mL/min/1.73 m(2). Baseline data and glycemic control after a one-year follow-up are presented here.


RESULTS
Data from 986 adult patients were analyzed. Mean age was 70 years. Mean eGFR was 42 mL/min/1.73 m(2), 66% of patients had proteinuria above 1g/day. HbA1c was higher in patients with lower eGFR in a model adjusted to age, gender, body mass index, hemoglobin level and erythropoietin use. Statistical significance was lost when stepwise multivariate analysis took into account the type of pharmacological treatment used to treat hyperglycemia.The type of antidiabetic agents differed across eGFR strata. Below 60 mL/min/1.73 m(2), the use of metformin declined while the use of insulin increased.After one year of follow up, 35% of patients had persistently poor or worsened glycemic control (HbA1c>8%). The only covariate independently associated with this characteristic was the duration of insulin therapy.


CONCLUSIONS
In patients with T2D and overt nephropathy, the observed correlation of low eGFR with high HbA1c was not predicted by eGFR. Our data rather underscore a different use of antidiabetic treatments in patients with advanced renal dysfunction, and the difficulty to improve glycemic control in patients with long standing insulin therapy.
Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France. Electronic address: doume.joly@gmail.com.
Dominique
D
Joly
University Picardie Jules Verne, Nephrology Dialysis Transplantation Department, CHU Amiens and INSERN UMR 1088, Amiens, France. Electronic address: choukroun.gabriel@chu-amiens.fr.
Gabriel
G
Choukroun
Université Bordeaux Segalen, Service de Néphrologie Transplantation Dialyse, CHU de Bordeaux and INSERM U1026, Bordeaux, France. Electronic address: christian.combe@chu-bordeaux.fr.
Christian
C
Combe
Aix-Marseille Université, Faculté de Médecine, Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception, Marseille, France. Electronic address: Bertrand.DUSSOL@ap-hm.fr.
Bertrand
B
Dussol
Université Claude Bernard Lyon, Génomique Fonctionnelle de l'Hypertension artérielle, EA 4173, Hôpital Nord-Ouest, Villefranche sur Saône and Department of Nephrology-Hypertension, Hospices Civils de Lyon, Lyon, France. Electronic address: jean-pierre.fauvel@chu-lyon.fr.
Jean-Pierre
JP
Fauvel
Université François-Rabelais, Faculté de Médecine, Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours and EA4245, Tours, France. Electronic address: halimi@med.univ-tours.fr.
Jean-Michel
JM
Halimi
Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France. Electronic address: stephane.quere@novartis.com.
Stéphane
S
Quéré
Clinical Affairs, Novartis Pharma SAS, Rueil-Malmaison, France. Electronic address: beatrice.fiquet@novartis.com.
Béatrice
B
Fiquet
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D011446:Prospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin
ALICE-PROTECT study; Glomerular filtration rate; Glycemic control; Overt nephropathy; Type 2 diabetes