Fasting Blood Glucose-A Missing Variable for GFR-Estimation in Type 1 Diabetes?

Bjornstad, Petter; McQueen, R. Brett; Snell‐Bergeon, Janet K.; Cherney, David Z.I.; Pyle, Laura; Perkins, Bruce A.; Rewers, Marian; Maahs, David M.

doi:10.1371/journal.pone.0096264

Cited by 12 publications

(10 citation statements)

References 39 publications

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“…Phenotypes of early diabetic nephropathy, including albuminuria, and hyperfiltration which manifest prior to renal function loss in adolescents, are thought to be strong predictors of cardiorenal complications in adulthood (14)(15)(16)(17)31). We used eGFR ≥135 mL/min/1.73 m 2 to define hyperfiltration, although there is no accepted definition for hyperfiltration (32,33). It is increasingly recognized that increased GFR is an early hemodynamic abnormality seen in diabetes that is linked with an increased risk of diabetic nephropathy (4).…”

Section: Discussionmentioning

confidence: 99%

Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes

et al. 2015

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Objective Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for HbA1c, blood pressure, lipids, and BMI. We hypothesized that ISPAD/ADA goal achievement at baseline would be associated with cardiorenal risk factors at baseline and 2 year follow-up in adolescents with type 1 diabetes. Methods We assessed the cross-sectional and longitudinal relationships between ISPAD/ADA goal achievement at baseline and cardiorenal health at baseline and 2-year follow-up (n=297; 15.4±2.1 years at baseline) in adolescents with type 1 diabetes. Goal achievement was defined as HbA1c<7.5%, BP<90th percentile for age, sex and height, LDL-C <100mg/dL, HDL-C >35mg/dL, TG <150mg/dL and BMI <85th percentile for age and sex. Cardiorenal outcomes included pulse-wave velocity (PWV), brachial distensibility (BrachD), augmentation index (AIx), and eGFR continuously and categorically as hyperfiltration (eGFR≥135mL/min/1.73m2). Results Adolescents with type 1 diabetes who met 1–3 goals, had significantly greater (P<0.05) baseline PWV (5.1±0.1 vs. 5.4±0.1 m/s), follow-up PWV (5.5±0.1 vs. 5.7±0.1 m/s), greater follow-up eGFR (104±2 vs. 116±3 mL/min/1.73m2), and greater odds of renal hyperfiltration at follow-up (OR: 20.0, 95% CI 3.8–105.2) compared to those who met 4–6 goals after adjusting for Tanner stage, sex, age and diabetes duration. No statistically significant differences in the cardiorenal outcomes were observed between adolescents with type 1 diabetes who met 4–6 goals and non-diabetic controls (n=96). Conclusions In adolescents with type 1 diabetes, baseline ADA/ISPAD goal achievement was associated with cardiorenal protection at baseline and 2-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes

et al. 2015

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“…However, to minimize the effect of the sample size, we used careful physiological measurements, including direct insulin sensitivity assessments by hyperinsulinemic-euglycemic clamp studies, accepted as the gold-standard method for determining insulin sensitivity. Moreover, we measured adiposity by using standardized DEXA and could therefore evaluate the association between adiposity and DN, and normalized glucose for an extensive period and standardized activity and diet to eliminate the confounding impacts of acute glycemia, exercise, and macronutrient content on renal measures ( 35 ). Although we attempted to remove the effect of acute glycemia on insulin sensitivity and the renal measures as much as possible, we cannot completely rule out the confounding effects of more chronic glucose toxicity.…”

Section: Discussionmentioning

confidence: 99%

Insulin Sensitivity Is an Important Determinant of Renal Health in Adolescents With Type 2 Diabetes

et al. 2014

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OBJECTIVEDiabetic nephropathy (DN) remains the most common cause of end-stage renal disease and is a major cause of mortality in type 2 diabetes. Insulin sensitivity is an important determinant of renal health in adults with type 2 diabetes, but limited data exist in adolescents. We hypothesized that measured insulin sensitivity (glucose infusion rate [GIR]) would be associated with early markers of DN reflected by estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in adolescents with type 2 diabetes.RESEARCH DESIGN AND METHODSType 2 diabetic (n = 46), obese (n = 29), and lean (n = 19) adolescents (15.1 ± 2.2 years) had GIR measured by hyperinsulinemic-euglycemic clamps. ACR was measured and GFR was estimated by the Bouvet equation (combined creatinine and cystatin C).RESULTSAdolescents with type 2 diabetes had significantly lower GIR, and higher eGFR and ACR than obese or lean adolescents. Moreover, 34% of type 2 diabetic adolescents had albuminuria (ACR ≥30 mg/g), and 24% had hyperfiltration (≥135 mL/min/1.73 m2). Stratifying ACR and eGFR into tertiles, adolescents with type 2 diabetes in the highest tertiles of ACR and eGFR had respectively lower GIR than those in the mid and low tertiles, after adjusting for age, sex, Tanner stage, BMI, and HbA1c (P = 0.02 and P = 0.04). GIR, but not HbA1c, LDL, or systolic blood pressure, was also associated with eGFR after adjusting for sex and Tanner stage (β ± SE: −2.23 ± 0.87; P = 0.02).CONCLUSIONSA significant proportion of adolescents with type 2 diabetes showed evidence of early DN, and insulin sensitivity, rather than HbA1c, blood pressure, or lipid control, was the strongest determinant of renal health.

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“…Obesity is common in diabetic patients [27] , leading to a relative low body muscle mass [28] , influenced the generation of creatinine in the body. And hyperglycemia status in diabetic patients influences the measurement of GFR [29] . Second, GFR measurement method in this study was calibrated to the dual sample DTPA clearance.…”

Section: Discussionmentioning

confidence: 99%

A New Modified CKD-EPI Equation for Chinese Patients with Type 2 Diabetes

et al. 2014

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ObjectiveTo improve the performance of glomerular filtration rate (GFR) estimating equation in Chinese type 2 diabetic patients by modification of the CKD-EPI equation.Design and patientsA total of 1196 subjects were enrolled. Measured GFR was calibrated to the dual plasma sample 99mTc-DTPA-GFR. GFRs estimated by the re-expressed 4-variable MDRD equation, the CKD-EPI equation and the Asian modified CKD-EPI equation were compared in 351 diabetic/non-diabetic pairs. And a new modified CKD-EPI equation was reconstructed in a total of 589 type 2 diabetic patients.ResultsIn terms of both precision and accuracy, GFR estimating equations all achieved better results in the non-diabetic cohort comparing with those in the type 2 diabetic cohort (30% accuracy, P≤0.01 for all comparisons). In the validation data set, the new modified equation showed less bias (median difference, 2.3 ml/min/1.73 m2 for the new modified equation vs. ranged from −3.8 to −7.9 ml/min/1.73 m2 for the other 3 equations [P<0.001 for all comparisons]), as was precision (IQR of the difference, 24.5 ml/min/1.73 m2 vs. ranged from 27.3 to 30.7 ml/min/1.73 m2), leading to a greater accuracy (30% accuracy, 71.4% vs. 55.2% for the re-expressed 4 variable MDRD equation and 61.0% for the Asian modified CKD-EPI equation [P = 0.001 and P = 0.02]).ConclusionA new modified CKD-EPI equation for type 2 diabetic patients was developed and validated. The new modified equation improves the performance of GFR estimation.

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Fasting Blood Glucose-A Missing Variable for GFR-Estimation in Type 1 Diabetes?

Cited by 12 publications

References 39 publications

Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes

Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes

Insulin Sensitivity Is an Important Determinant of Renal Health in Adolescents With Type 2 Diabetes

A New Modified CKD-EPI Equation for Chinese Patients with Type 2 Diabetes

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