Dataset Information

Visit-to-visit variability in albuminuria predicts renal function deterioration in patients with type 2 diabetes.

ABSTRACT:

Aims/introduction

We aimed to study the predictive ability of visit-to-visit variability in albuminuria for changes in renal function in patients with type 2 diabetes mellitus.

Materials and methods

The cohort study was carried out in a single medical center. In the model development cohort of 1008 subjects, we developed the albuminuria variability score (AVS) to evaluate the visit-to-visit variability in albuminuria, which was the percentage of the number of changes in the urine albumin : creatinine ratio ≥3.39 mg/mmol among all visit-to-visit urine albumin : creatinine ratio differences within an individual. Multivariate logistic regression was applied to predict the influence of AVS levels on the occurrence of study end-points. In another independent validation cohort of 310 participants, survival analysis was carried out to evaluate the ability of AVS in predicting the study end-point.

Results

In the model development cohort, a higher AVS was associated with higher adjusted odds of having a declined or rapidly declined estimated glomerular filtration rate (eGFR) trajectory (1.84, 95% confidence interval 1.23-2.76 and 5.70, 95% confidence interval 2.28-14.25, respectively), a resultant eGFR <60 mL/min/1.73 m² (2.61, 95% confidence interval 1.63-4.16) and a >40% decline in eGFR from baseline (6.44, 95% confidence interval 2.15-19.26). In the validation cohort, a higher AVS independently predicted a 5-year decrease of >40% in eGFR to <60 mL/min/1.73 m² (adjusted hazard ratio 3.33, 95% confidence interval 1.10-10.05). Integrated discrimination index and concordance statistics showed that AVS significantly improved the predictive ability of the models.

Conclusions

Visit-to-visit variability in albuminuria can independently predict long-term renal function deterioration in patients with type 2 diabetes mellitus. Further investigations are warranted to elucidate the potential clinical applications.

SUBMITTER: Lin CH

PROVIDER: S-EPMC9153848 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Visit-to-visit variability in albuminuria predicts renal function deterioration in patients with type 2 diabetes.

Lin Chih-Hung CH Lai Ying-Chuen YC Chang Tien-Jyun TJ Jiang Yi-Der YD Chang Yi-Cheng YC Chuang Lee-Ming LM

Journal of diabetes investigation 20220216 6

<h4>Aims/introduction</h4>We aimed to study the predictive ability of visit-to-visit variability in albuminuria for changes in renal function in patients with type 2 diabetes mellitus.<h4>Materials and methods</h4>The cohort study was carried out in a single medical center. In the model development cohort of 1008 subjects, we developed the albuminuria variability score (AVS) to evaluate the visit-to-visit variability in albuminuria, which was the percentage of the number of changes in the urine ...[more]

PMID: 35100497

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Project description:Background and purposeDiabetes is associated with cognitive decline as well as the development of dementia. Although mean blood glucose levels are typically used to assess the status of diabetic patients, glucose variability is also involved in the manifestation of macro- and microvascular complications in this population. Thus, the present study sought to determine whether visit-to-visit glucose variability contributes to cognitive decline in patients with type 2 diabetes.MethodsThe present study assessed 68 patients with type 2 diabetes using several validated neuropsychological measures. All patients had no cerebrovascular disease, history of hypoglycemia, psychiatric conditions, or other medical illnesses. Standard deviations (SDs) and coefficients of variance (CVs) of the patients' blood glucose (after fasting and 2 hours postprandial; FBS and PP2), and glycated hemoglobin (HbA1c) values were used as indices of glucose variability. The cognitive outcome parameters were transformed with z-scores and entered into a multiple linear regression model that included educational status, age, sex, vascular risk factors, and mean glucose parameters as covariates.ResultsThe mean age of the total patient population was 70.9 years; 46 (67.6%) of the patients were men, and the median follow-up duration at our endocrinology outpatient clinic was 4.8 years. The mean FBS and PP2 glucose levels of the patients were 132 mg/dL and 199 mg/dL, respectively, and the mean HbA1c level was 8.0%. A univariable analysis revealed that only the PP2 value was associated with the Mini-Mental State Examination (MMSE) score, and multivariable analysis revealed that a high SD and/or CV for PP2 glucose were associated with low scores on the Rey Complex Figure Copy test and/or the Verbal Learning Test. Additionally, a high SD and a higher CV for HbA1c level were significantly associated with low MMSE and Digit Span test scores even after adjusting for mean HbA1c values.ConclusionsThe present data indicate that a greater degree of visit-to-visit glucose variability influenced specific types of cognitive function in type 2 diabetic patients independently of mean blood glucose levels. Future studies should focus on whether reductions in glycemic variability will improve the cognitive decline observed in type 2 diabetic patients.

Dataset Information

Visit-to-visit variability in albuminuria predicts renal function deterioration in patients with type 2 diabetes.

Aims/introduction

Materials and methods

Results

Conclusions

Publications

Visit-to-visit variability in albuminuria predicts renal function deterioration in patients with type 2 diabetes.

Similar Datasets

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