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. 2014 Oct 31;9(10):e111173.
doi: 10.1371/journal.pone.0111173. eCollection 2014.

Fluctuation between fasting and 2-H postload glucose state is associated with glomerular hyperfiltration in newly diagnosed diabetes patients with HbA1c < 7%

Xinguo Hou  1 , Chuan Wang  1 , Shaoyuan Wang  2 , Weifang Yang  2 , Zeqiang Ma  3 , Yulian Wang  4 , Chengqiao Li  4 , Mei Li  4 , Xiuping Zhang  5 , Xiangmin Zhao  5 , Yu Sun  1 , Jun Song  1 , Peng Lin  1 , Kai Liang  1 , Lei Gong  1 , Meijian Wang  1 , Fuqiang Liu  1 , Wenjuan Li  1 , Fei Yan  1 , Junpeng Yang  1 , Lingshu Wang  1 , Meng Tian  1 , Jidong Liu  1 , Ruxing Zhao  1 , Shihong Chen  6 , Li Chen  1
Affiliations

Fluctuation between fasting and 2-H postload glucose state is associated with glomerular hyperfiltration in newly diagnosed diabetes patients with HbA1c < 7%

Xinguo Hou et al. PLoS One. .

Abstract

Objective: To investigate whether fluctuations between the fasting and 2-h postload glucose ([2-hPBG]-fasting blood glucose [FBG]) states are associated with glomerular hyperfiltration (GHF) in middle-aged and elderly Chinese patients with newly diagnosed diabetes.

Design and methods: In this study, we included 679 newly diagnosed diabetes patients who were ≥ 40 years old. All the subjects were divided into two groups; those with HbA1c<7% and ≥ 7%. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). GHF was defined as an eGFR ≥ the 90th percentile. First, a multiple linear regression analysis was used to estimate the association of 2-hPBG-FBG with eGFR. Then, a generalized additive model was used to explore the possible nonlinear relationship between 2-hPBG-FBG and eGFR. Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and ≥ 108 mg/dl. Finally, a multiple logistic regression analysis was used to investigate the association of 2-hPBG-FBG with the risk of GHF.

Results: For the group with HbA1c<7%, the eGFR and the percentage of GHF were significantly higher compared with the group with HbA1c ≥ 7%. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and glycated hemoglobin (HbA1c), 2-hPBG-FBG was significantly associated with increased eGFR and an increased risk of GHF (the GHF risk increased by 64.9% for every 36.0 mg/dl [2.0 mmol/L] 2-hPBG-FBG increase) only in those patients with HbA1c<7%. Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).

Conclusions: Increased fluctuations between the fasting and 2-h postload glucose states are closely associated with increased eGFR and an increased risk of GHF in newly diagnosed diabetes patients with HbA1c<7%.

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Conflict of interest statement

Competing Interests: ZM is an employee of China National Heavy Duty Truck Group Corporation Hospital. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Nonlinear association of the difference between 2-h postload blood glucose and fasting blood glucose (2-hPBG-FBG) in association with estimated glomerular filtration rate (eGFR).
The association was analyzed in a generalized additive model (df = 3, P<0.001) adjusted for age, gender, BMI, systolic BP, diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and HbA1c.
See this image and copyright information in PMC

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