title: Postmeal triglyceridemia and variability of HbA1c and postmeal glycemia were predictors of annual decline in estimated glomerular filtration rate in type 2 diabetic patients with different stages of nephropathy.
abstract: BACKGROUND
  This study examined associations of annual glycemic variability and postprandial dysmetabolism with annual decline in estimated glomerular filtration rate (eGFR) in type 2 diabetic patients with different stages of nephropathy.
  
  
  METHODS
  Intrapersonal mean and coefficient of variation (CV) of HbA1c, fasting and postmeal concentrations of plasma glucose (FPG and PMPG, respectively) and serum triglycerides (FTG and PMTG, respectively) during the first 12 months after enrollment were calculated in a cohort of 168 type 2 diabetic patients: 53 with optimal albumin/creatinine ratio (ACR < 10 mg/g), 62 with high normal ACR (10-29 mg/g) and 53 with elevated ACR (≧30 mg/g). Annual changes in eGFR were computed using 52 (median) creatinine measurements obtained over a median follow-up of 6.0 years. Multivariate linear regressions assessed the independent correlates of changes in eGFR.
  
  
  RESULTS
  Kidney function declined faster in patients with high normal and elevated ACR (-1.47 and -2.01 ml/min/1.73 m2/year, respectively) compared to patients with optimal ACR (0.08 ml/min/1.73 m2/year,p< 0.05). In patients with high normal ACR, age (standardized β、-0.30、p= 0.01), CV-HbA1c (standardized β、-0.66、p< 0.001) and CV-PMPG (standardized β、-0.27、p= 0.01) was associated with annual eGFR decline independently of mean HbA1c and PMPG, sex, BMI, waist circumference, diabetes duration and therapy, means and CVs of FPG and systolic blood pressure, baseline eGFR, log ACR and uses of anti-hypertensive medications (R2= 0.47). In patients with elevated ACR, PMTG (standardized β、-0.408,p= 0.007) was associated with annual eGFR decline (R2= 0.15).
  
  
  CONCLUSIONS
  Consistency of glycemic control and management of postprandial glycemia and lipidemia are important to preserve kidney function in type 2 diabetic patients.
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan ; Department of Nutrition, Osaka City Juso Hospital, Osaka, 532-0034 Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Tsuboi
authors.affiliation: Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takenouchi
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan ; Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Kurata
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan ; Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Fukuo
authors.affiliation: Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki-cho, Nishinomiya, Hyogo 663-8558 Japan ; Diabetes Division, Kohnan Kakogawa Hospital, Kakogawa, Hyogo, 675-0005 Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kazumi
keywords: Coefficient of variation; HbA1c; Kidney function; Postmeal glucose; Postmeal triglycerides; eGFR