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. 2020 Jun 22:2020:9806790.
doi: 10.1155/2020/9806790. eCollection 2020.

Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Ye An Kim  1 , Young Lee  2 , Je Hyun Seo  2
Affiliations

Renal Complication and Glycemic Control in Korean Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study

Ye An Kim et al. J Diabetes Res. .

Abstract

Objective: Tight glycemic control reduces the risk of diabetes complications, but it may increase the risk of hypoglycemia or mortality in elderly patients. This study is aimed at evaluating the incidence and progression of renal complications and its association with glycemic control in elderly patients with type 2 diabetes.

Methods: This retrospective cohort study examined the data of 3099 patients with type 2 diabetes who were followed for at least 10 years at the Korean Veterans Hospital and for whom glycated hemoglobin (HbA1c) was measured in 2008 and 2017. Participants were divided into six groups according to their baseline or dynamic HbA1c levels. Extended Cox models were used to calculate adjusted hazard ratios for the development of chronic kidney disease (CKD) and end-stage renal disease (ESRD) associated with specific HbA1c ranges.

Results: During the 10-year follow-up period, 30% of patients developed new CKD, 50% showed progression, and ESRD developed in 1.7%. The risk of CKD was associated with baseline HbA1c from the first year of the study and dynamic HbA1c throughout the study period. The adjusted hazard ratios for CKD were 1.98 and 2.32 for baseline and dynamic HbA1c, respectively, at the level of ≥69 mmol/mol. There was no increased risk for any complications in baseline and dynamic HbA1c below 58 mmol/mol.

Conclusions: A higher HbA1c ≥ 58 mmol/mol was associated with an increased risk of diabetes complications. A less stringent glycemic target of HbA1c could be used as the threshold of renal complications.

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Conflict of interest statement

All of the authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Development of chronic kidney disease (CKD) in the CKD-naïve group and CKD progression in the preexisting CKD group after 10 years. Abbreviations: CKD: chronic kidney disease; ESRD: end-stage renal disease; eGFR: estimated glomerular filtration rate.
Figure 2
Figure 2
Kaplan-Meier curves for the development or progression of chronic kidney disease according to baseline glycated hemoglobin. Abbreviations: HbA1c: glycated hemoglobin; CKD: chronic kidney disease; No.: number. Kaplan-Meier curves stratified by baseline HbA1c into six groups. Renal outcome was defined as a composite event of the first CKD development in the CKD-naïve group (n = 2357) and CKD progression in the preexisting CKD group (n = 412).
Figure 3
Figure 3
Kaplan-Meier curves for the development of end-stage renal disease according to baseline glycated hemoglobin. Abbreviations: HbA1c: glycated hemoglobin; ESRD: end-stage renal disease; No.: number. Kaplan-Meier curves stratified by baseline HbA1c into six groups. Renal outcome was defined as the first ESRD development in all subjects including CKD naïve (n = 2357), normal GFR with albuminuria (n = 330), and preexisting CKD (n = 412).
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