Aim To investigate the association between baseline plasma zinc-a2-glycoprotein and non-albuminuric chronic kidney disease progression in type 2 diabetes. Methods Adults with normoalbuminuria at entry (n=341; age 57AE10 years, 52% men) were analysed. Chronic kidney disease progression was defined as a decrease in chronic kidney disease stage and a decline of ≥25% in estimated GFR from baseline. Baseline plasma zinc-a2-glycoprotein levels were quantified by immunoassay, and analysed either as a continuous variable or by tertiles in Cox proportional hazards models. Model discrimination was assessed using Harrell's C-index. A sensitivity analysis was performed on a subset of individuals who maintained normoalbuminuria during follow-up. Results Chronic kidney disease progression occurred in 54 participants (16%). Zinc-a2-glycoprotein levels were elevated in chronic kidney disease progressors (P = 0.011), and more progressors were assigned to the higher zinc-a2glycoprotein tertile than non-progressors. In the unadjusted Cox model, zinc-a2-glycoprotein, both as a continuous variable (hazard ratio 1.72, 95% CI 1.08-2.75) and tertile 3 (vs tertile 1; hazard ratio 2.14, 95% CI 1.10-4.17), predicted chronic kidney disease progression. The association persisted after multivariable adjustment. The C-index of the Cox model increased significantly after incorporation of zinc-a2-glycoprotein into a base model comprising reninangiotensin system antagonist usage. Sensitivity analysis showed that zinc-a2-glycoprotein independently predicted chronic kidney disease progression among individuals who maintained normoalbuminuria during follow-up. Conclusions Plasma zinc-a2-glycoprotein is associated with chronic kidney disease progression, and may serve as a useful early biomarker for predicting non-albuminuric chronic kidney disease progression in type 2 diabetes.

Handgrip strength (HGS) is a simple, reliable method to measure muscle strength and assessing sarcopenia. Insulin resistance (IR) is important contributing factor to cardiovascular disease and also related with sarcopenia. In this study, we investigated the association between IR and muscle strength via the Triglyceride glucose index (TyG) index and HGS. We used data from the sixth Korean National Health and Nutrition Examination Survey to evaluate a total of 10048 subjects aged over 40. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] to represent IR. We defined absolute HGS as sum of the maximum values of the right and left sides of each of the three measurements. The relative HGS was calculated by dividing the absolute HGS by body mass index. The subjects were stratified into quartiles according to the TyG index. Relative HGS was decreased as the TyG index increased in total subjects. In linear regression analysis, relative HGS showed negative correlation with metabolic parameter and the TyG index in all groups of age and gender. According to logistic regression analysis after adjusting for multiple risk factors, odds ratio (95% CI) for low muscle strength (defined as the lower 10% on relative HGS) for the highest and lowest quartiles of the TyG index was 2.513 in male and 2.161 in female on total subjects. In group of subjects with mid-age (age between 40 to 64 years old), the prevalence of low muscle strength was positively correlated with increased the TyG index both in male and female. However, in the elderly groups (age over 65 years old), relationships between the increased the TyG index quartiles and prevalence of low muscle strength were not significant in all subjects. In conclusion, the TyG index was independently associated with relative HGS and low muscle strength in mid-aged subject and could have predictive value for sarcopenia and further metabolic disease. Disclosure S.Lee: None. Y.Choi: None. M.Kim: None.

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