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

摘要

BackgroundThis 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. MethodsIntrapersonal 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 ResultsKidney 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 p =?0.01), CV-HbA1c (standardized β、-0.66、 p 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). ConclusionsConsistency of glycemic control and management of postprandial glycemia and lipidemia are important to preserve kidney function in type 2 diabetic patients.