OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes. RESEARCH DESIGN AND METHODS Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%. RESULTS Of 5,674 patients, 3,637 (64.1%) received insulin at baseline. Overall, 5,663 patients were included in the analysis for HbA1c; 2,794 (49.3%) had baseline HbA1c <7.5% (58 mmol/mol). Finerenone significantly reduced risk of the kidney composite outcome independent of baseline HbA1c level and insulin use (Pinteraction = 0.41 and 0.56, respectively). Cardiovascular composite outcome incidence was reduced with finerenone irrespective of baseline HbA1c level and insulin use (Pinteraction = 0.70 and 0.33, respectively). Although baseline HbA1c level did not affect kidney event risk, cardiovascular risk increased with higher HbA1c level. UACR reduction was consistent across subgroups. Adverse events were similar between groups regardless of baseline HbA1c level and insulin use; few finerenone-treated patients discontinued treatment because of hyperkalemia. CONCLUSIONS Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use.

According to latest guidelines hemoglobin A1C plays a central role in the diagnosis of diabetes mellitus. It is well-known from epidemiologic studies that a high rate of diabetic patients enters into dialysis programs and these patients have an unfavourable mortality outcome. Based on surveys conducted in recent years in this patient group, hemoglobin A1C has an important role in assessing carbohydrate metabolism. However, there are several factors independent of blood glucose may affect hemoglobin A1C values both in hemodialysis and peritoneal dialysis patients. Hemodialysis disturbs hemoglobin A1c assessment because of an accelerated turnover of lost red blood cells. During peritoneal dialysis a considerable amount of glucose may be absorbed from the peritoneal solutions that may influence hemoglobin A1C level. Several alternative markers such as glycated albumin and fructosamine have been evaluated but they failed to have prognostic advantage. It has been concluded that among dialysis patients the hemoglobin A1C range between 6.5 and 8% is associated with the lowest mortality risk.

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Relationship between skin autofl uorescence and conventional glycemic markers in patients with diabetesIntroduction: Skin autofl uorescence has a well-known signifi cance for screening diabetes and early diagnosis of vascular complications. It predicts cardiovascular events better than hemoglobin A1c, hence skin autofl uorescence is a marker of cumulative tissue glycemic load whereas hemoglobin A1c refl ects changes occurring in the previous 6-8 weeks. Aim: The aim of the authors was analyze the relationship between skin autofl uorescence and conventional glycemic markers in patients with diabetes. Method: Skin autofl uorescence measurements were performed in 2010 in 18 patients (10 men and 8 women with normal glomerular fi ltration rate; age, 61.4±13.8 years) with long term follow-up (2624 months, 476 laboratory results). Relationships between skin autofl uorescence values and fasting blood glucose, hemoglobin A1c levels and metabolic parameters obtained before and after skin autofl uorescence measurements were analysed using Spearman rank test. Results: The average skin autofl uorescence value was 2.88±0.65 arbitrary units. There were no signifi cant correlations between skin autofl uorescence and hemoglobin A1c levels obtained before (7.84±1.08%, p = 0.07) and after the skin autofl uorescence measurements (7.45±1.18%, p = 0.71). Skin autofl uorescence values also failed to show relationship with fasting blood glucose obtained before (p = 0.09) and after (p = 0.29) the skin autofl uorescence measurements. Conclusions: In patients with diabetes skin autofl uorescence may provide novel information about glycemic burden. Skin autofl uorescence values (which may presumably provide a more accurate estimation of the cardiovascular risk) do not correlate with hemoglobin A1c and fasting blood glucose Keywords: skin autofl uorescence, hemoglobin A1c, cardiovascular riskMácsai, E., Rakk, E., Miléder, M., Fulcz, Á. [Relationship between skin autofl uorescence and conventional glycemic markers in patients with diabetes]. Orv. Hetil., 2015, 156(33) EREDETI KÖZLEMÉNYRövidítések AGE = glikációs végtermékek; CABG = coronaria arteria bypass graft; CACS = coronaria arteria kalcifi kációs score; CGMS = (continuous glucose monitoring system) szövetiglü-kóz-szint monitorozása; CKD = krónikus veseelégtelenség; GFR = glomerulusfi ltrációs ráta; HbA 1c = hemoglobin-A-1c; IGT = csökkent glükóztolerancia; PAD = perifériás artériás betegség; RAGE = (receptor for AGE) glikációs végtermékek receptora; SAF = bőr-autofl uoreszcencia; T1DM = diabetes mellitus 1-es típus; T2DM = diabetes mellitus 2-es típus