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Baseline glycaemic control, family diabetes history predict T2DM in chronic kidney disease

17 Sep 2018

Patients with chronic kidney disease appear to be at greater risk of developing type 2 diabetes mellitus (T2DM) compared with the general population, with predictors including poor baseline glycaemic control and family history of diabetes mellitus, a study has found.

The analysis included 1,713 patients (mean age 56.2 years; 52.9 percent male) with reduced glomerular filtration rates enrolled in the Chronic Renal Insufficiency Cohort study. Researchers obtained data on kidney function and damage, fasting blood glucose, haemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), demographics, family history of diabetes and smoking status, among others.

During a mean follow-up of 6.65 years, 203 patients (11.85 percent) developed T2DM (defined as fasting blood glucose ≥126 mg/dL or prescription of insulin or oral hypoglycaemic agents). The overall T2DM incidence rate was 17.81 cases/1,000 person-years.

Concordance was low between fasting blood glucose and HbA1c levels (κ=18 percent). In multivariable cause-specific hazards modelling, T2DM showed a significant association with fasting blood glucose level (adjusted hazard ratio [aHR], 1.407; 95 percent CI, 1.135–1.744; p=0.002) and family history of T2DM (aHR, 1.498; 1.033–2.172; p=0.03).

The adjusted association of T2DM with HOMA-IR (aHR, 1.442; 1.208–1.721; p<0.001) was comparable to that observed for fasting blood glucose level, while the association observed for HbA1c level was nonsignificant (aHR, 1.183; 0.966–1.449; p=0.1).

Measures of kidney function and damage were not associated with T2DM.

The results provide clear evidence that in a CKD population, measures of glycaemic control (fasting blood glucose and/or HOMA-IR) have a moderate predictive value for the risk of incident T2DM, even among individuals classified as normoglycaemic by fasting blood glucose level, researchers pointed out.

Limitations of the study include the small number of outcome events and predictors being restricted to measures taken at baseline, they added.

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Most Read Articles
Stephen Padilla, 14 Aug 2019
Early administration of recombinant human B-type natriuretic peptide (rhBNP) can lower the incidence of reperfusion injury for patients with ST-elevation myocardial infarction (STEMI) who are receiving percutaneous coronary intervention (PCI) treatment, according to a China study.
11 Aug 2019
Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.
3 days ago
Pulmonary function has potential predictive value for future increases in arterial stiffness and its progression, as reported in a recent study.
2 days ago
Systolic blood pressure appears to have a strong association with aneurysmal subarachnoid haemorrhage (aSAH) but not with unruptured intracranial aneurysm (UIA), whereas current smoking and female sex are risk factors for both conditions, a study has found.