HbA1c Fluctuations Lead to Diabetic Nephropathy
In a large cohort study on the association between HbA1c variability and nephropathy, researchers showed that HbA1c fluctuations lead to diabetic nephropathy (kidney disease) in type 2 patients. The researchers conducted a cohort study from the Renal Insufficiency and Cardiovascular Events (RIACE) Italian multicenter study.
The study examined 15,933 white patients with type 2 diabetes. Also, they collected at 3 to 5 HbA1c values in 52% of patients over 2 years prior to study entry. The average patient age was 68 years old and the average duration of diabetes was 14 years. Median and interquartile ranges of HbA1c-MEAN and HbA1c c-SD were 7.57% (range, 6.86% – 8.38%) and 0.46% (range, 0.29% – 0.74%).
When HbA1c-SD was added to HbA1c-MEAN, it served as an independent associate of microalbuminuria and stage 1 to 2 chronic kidney disease. Also, it served as an independent predictor of macroalbuminuria and stage 3 to 5 chronic kidney disease. The HbA1c-MEAN did not correlate with any of these outcomes. However, it did correlate with diabetic retinopathy.
The authors concluded, “In patients with type 2 diabetes, HbA1c variability affects albuminuria and albuminuric CKD phenotypes independently of (or instead of) average HbA1c, even after adjustment for known risk factors for microvascular complications. On the contrary, HbA1c variability has no effects on diabetic retinopathy, which is mainly dependent on HbA1c.”
This shows the importance of consistently maintaining HbA1c values in the normal range to avoid microvascular problems in the future.
Health-e-Solutions comment: We agree completely with the need to keep HbA1c values in the normal range. We think the Health-e-Solutions lifestyle has facilitated that for our two boys with type 1 diabetes. We also think the healthy lifestyle has put their bodies in a position of strength to resist further insults from potential environmental factors that may cause disease progression.
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Diabetes Care. March 14, 2013. doi: 10.2337/dc12-2264