title: Effect of long-term glycemic variability on estimated glomerular filtration rate decline among patients with type 2 diabetes mellitus: Insights from the Diabetic Nephropathy Cohort in Singapore.
abstract: BACKGROUND
  In the present study, we examined the association between HbA1c variability and renal disease progression based on estimated glomerular filtration rate (eGFR) decline in patients with type 2 diabetes mellitus (T2DM) in Singapore.
  
  
  METHODS
  Glycemic burden and renal function were retrospectively assessed in 1628 patients in 2002-2014. Multivariable logistic regression was used to assess the relationships between HbA1c variability (expressed as HbA1c coefficient of variation [HbA1c-CV] in quartiles), HbA1c intrapersonal mean (HbA1c-IM), and eGFR decline, adjusted for baseline covariates.
  
  
  RESULTS
  Among patients with relatively good glycemic control (i.e. HbA1c-IM below the median cohort value [8.0%]), HbA1c-CV Quartile 4 was associated with eGFR decline (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.10-3.25). The OR for HbA1c-CV Quartile 4 was 2.20 (95% CI 1.24-3.89) after additional adjustment for HbA1c-IM. Where HbA1c-IM was above the median cohort value, HbA1c-CV Quartiles 3 and 4 were associated with eGFR decline, with ORs of 2.60 (95% CI 1.48-4.55) and 3.29 (95% CI 1.89-5.76) respectively. After further adjusting for HbA1c-IM, the ORs for Quartiles 3 and 4 were 2.69 (95% CI 1.53-4.74) and 3.51 (95% CI 1.98-6.21), respectively.
  
  
  CONCLUSIONS
  Variability in HbA1c is strongly and independently associated with eGFR decline in patients with T2DM independent of mean HbA1c. The findings may highlight the importance of sustained stable glycemic control in management of diabetes mellitus.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Serena
authors.initials: S
authors.lastname: Low
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.|Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Su C
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Lee Y
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Yan L
authors.initials: YL
authors.lastname: Liu
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Jian J
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fun
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Chang
authors.initials: C
authors.lastname: Su
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Tavintharan
authors.initials: T
authors.lastname: Subramaniam
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Chee F
authors.initials: CF
authors.lastname: Sum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors
chemical_list: D001786:Blood Glucose
keywords: 2型糖尿病; HbA1c variability; HbA1c波动性; estimated glomerular filtration; progression; type 2 diabetes mellitus; 估算的肾小球滤过功能; 进展