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. 2025 May 15;16(5):102094.
doi: 10.4239/wjd.v16.i5.102094.

Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021

Chang Seong Kim  1   2 , Sang Heon Suh  1   2 , Hong Sang Choi  1   2 , Eun Hui Bae  1   2 , Seong Kwon Ma  1   2 , Bongseong Kim  3 , Kyung-Do Han  3 , Soo Wan Kim  1   4
Affiliations

Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021

Chang Seong Kim et al. World J Diabetes. .

Abstract

Background: Diabetes is a significant risk factor for chronic kidney disease, and diabetic kidney disease (DKD) is prevalent among patients with diabetes. Previous studies have indicated that the duration of diabetes and poor glycemic control are associated with an increased risk of DKD, but data on how the duration and severity of hyperglycemia specifically relate to DKD progression are limited.

Aim: To investigate the relationship between diabetes duration and glycemic control, and DKD progression in South Korea.

Methods: We included 2303 patients with diabetes using the 2019-2021 Korea National Health and Nutrition Examination Surveys data. DKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2, urinary albumin-to-creatinine ratio ≥ 30 mg/g, or both. Diabetes duration and severity were classified into six categories each.

Results: DKD prevalence was 25.5%. The DKD risk significantly increased in diabetes lasting 10-15 years or hemoglobin A1C (HbA1c) ≥ 8% compared to patients with newly diagnosed diabetes or HbA1c < 6.5%. Albuminuria developed with shorter diabetes duration and lower HbA1c than eGFR decline. The adjusted odds ratios for DKD were 3.77 [95% confidence interval (95%CI): 2.60-5.45] and 4.91 (95%CI: 2.80-8.63) in patients with diabetes lasting ≥ 20 years and HbA1c ≥ 10%, respectively, compared to those with new-onset diabetes and HgA1c < 6.5%.

Conclusion: Patients with diabetes lasting > 10 years or HbA1c > 8% had a higher risk of DKD, emphasizing the importance of early monitoring and management is crucial to prevent DKD progression.

Keywords: Albuminuria; Chronic kidney disease; Diabetic mellitus; Diabetic nephropathy; Glycemic control.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The trend in estimated glomerular filtration rate and urinary albumin-to-creatinine ratio in participants with diabetes mellitus. A: Estimated glomerular filtration rate (eGFR) and albuminuria trends according to the duration of diabetes; B: eGFR and albuminuria trends according to hemoglobin A1C levels. Models were adjusted for age, sex, regular exercise, and previous history of hypertension, dyslipidemia, and cardiovascular disease. DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; UACR: Urinary albumin creatinine ratio; HbA1c: Hemoglobin A1C.
See this image and copyright information in PMC

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