title: Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease.
abstract: BACKGROUND
  Maintaining tight glycemic control is important for prevention of diabetes-related outcomes in end-stage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease.
  
  
  METHODS
  Using data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) > 7 vs. ≤ 7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011.
  
  
  RESULTS
  Of 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients < 40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥ 40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c > 7.5 % and > 8 %.
  
  
  CONCLUSIONS
  In this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, 1070 Arastradero Road #3C3109, Palo Alto, CA, 94304, USA. rheej@stanford.edu.
authors.forename: Jinnie J
authors.initials: JJ
authors.lastname: Rhee
authors.affiliation: Division of Bioinformatics Research, Stanford University School of Medicine, Palo Alto, CA, USA. vding@stanford.edu.
authors.forename: Victoria Y
authors.initials: VY
authors.lastname: Ding
authors.affiliation: Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. drehkopf@stanford.edu.
authors.forename: David H
authors.initials: DH
authors.lastname: Rehkopf
authors.affiliation: Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Cristina.Arce@UTSouthwestern.edu.
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Arce
authors.affiliation: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. winkelma@bcm.edu.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D015984:Causality; D015897:Comorbidity; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D038321:Glycemic Index; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D017678:Sex Distribution; D013223:Statistics as Topic; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose