Glycated Hemoglobin and the Risk of Kidney Disease and Retinopathy in Adults With and Without Diabetes

Selvin, Elizabeth; Yang, Ning; Steffes, Michael W.; Bash, Lori D.; Klein, Michael L.; Wong, Tien Yin; Astor, Brad C.; Sharrett, A. Richey; Brancati, Frederick L.; Coresh, Josef

doi:10.2337/db10-1198

Cited by 121 publications

(112 citation statements)

References 35 publications

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“…Longitudinal studies did not find prediabetes to be an independent risk factor for albuminuria or incident CKD, defined as an estimated GFR < 60 ml/min/1.73 m 2 . [6][7][8][9][10][11] If prediabetes is a causal factor in the development of kidney disease, this condition would represent a window of opportunity to treat kidney damage at an early and reversible stage.…”

Section: Discussionmentioning

confidence: 99%

Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study

Melsom

Schei

Stefansson

et al. 2016

American Journal of Kidney Diseases

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Section: Discussionmentioning

confidence: 99%

Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study

Melsom

Schei

Stefansson

et al. 2016

American Journal of Kidney Diseases

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“…Although the risk of developing diabetesrelated complications rises steadily when glycated hemoglobin (HbA 1c ) values are in excess of 6.5% (48 mmol/mol) (4,5), an HbA 1c of ,7% (,53 mmol/mol) is generally considered a target goal for diabetes management (6). In truth, it is now widely recognized that individualizing the HbA 1c goal for each patient is critically important, especially when the presence of comorbidities necessitates less stringent targets (6).…”

Section: Achievement Of Hba 1c Goals In the Real Worldmentioning

confidence: 99%

Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control

2017

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Despite U.S. Food and Drug Administration (FDA) approval of over 40 new treatment options for type 2 diabetes since 2005, the latest data from the National Health and Nutrition Examination Survey show that the proportion of patients achieving glycated hemoglobin (HbA 1c ) <7.0% (<53 mmol/mol) remains around 50%, with a negligible decline between the periods 2003-2006 and 2011-2014. The Healthcare Effectiveness Data and Information Set reports even more alarming rates, with only about 40% and 30% of patients achieving HbA 1c <7.0% (<53 mmol/mol) in the commercially insured (HMO) and Medicaid populations, respectively, again with virtually no change over the past decade. A recent retrospective cohort study using a large U.S. claims database explored why clinical outcomes are not keeping pace with the availability of new treatment options. The study found that HbA 1c reductions fell far short of those reported in randomized clinical trials (RCTs), with poor medication adherence emerging as the key driver behind the disconnect. In this Perspective, we examine the implications of these findings in conjunction with other data to highlight the discrepancy between RCT findings and the real world, all pointing toward the underrealized promise of FDA-approved therapies and the critical importance of medication adherence. While poor medication adherence is not a new issue, it has yet to be effectively addressed in clinical practicedoften, we suspect, because it goes unrecognized. To support the busy health care professional, innovative approaches are sorely needed. ACHIEVEMENT OF HbA 1c GOALS IN THE REAL WORLDLarge randomized controlled trials (RCTs) have clearly demonstrated that achieving and sustaining optimal glycemic control prevents or delays the development of microvascular and macrovascular disease (1-3). Although the risk of developing diabetesrelated complications rises steadily when glycated hemoglobin (HbA 1c ) values are in excess of 6.5% (48 mmol/mol) (4,5), an HbA 1c of ,7% (,53 mmol/mol) is generally considered a target goal for diabetes management (6). In truth, it is now widely recognized that individualizing the HbA 1c goal for each patient is critically important, especially when the presence of comorbidities necessitates less stringent targets (6). However, most government and private insurer reports continue to use 7% as a point of reference; therefore, we focus herein on this marker of glycemic control.Despite our growing understanding of diabetes and the availability of new medications and technologies, a substantial number of individuals are not at their glycemic goal. Of note, recent data indicate that 85.6% of adults with diagnosed diabetes are treated with diabetes medication (7). Results from the National Health and Nutrition Examination Survey (NHANES) indicate that only about 50% of American adults with diabetes are achieving HbA 1c ,7.0% (,53 mmol/mol) (8), and it is estimated that only 64% are reaching individualized glycemic goals (9). These findings are noteworthy

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“…A large cohort study reported a strong association between fasting plasma glucose (FPG) level and renal function even in subjects without DM (6). Furthermore, hypertension and/or dyslipidemia frequently coexist with CKD, which are often associated with marked renal impairment (7,8).…”

Section: Introductionmentioning

confidence: 99%

Association of renal function with clinical parameters and conditions in a longitudinal population-based epidemiological study

et al. 2016

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Abstract. The aim of the present study was to examine the association of renal function with clinical parameters and conditions in the general population. Study subjects comprised 6,027 community-dwelling individuals who were recruited to the Inabe Health and Longevity Study: A longitudinal genetic epidemiological study of atherosclerotic, cardiovascular and metabolic diseases. The cutoff value, which was used to divide the subjects into those with normal and those with low estimated glomerular filtration rate (eGFR), was 60 ml/min/1.73 m 2 . Bonferroni's correction was applied to establish the statistical significance of the association. Longitudinal analysis using the generalized linear mixed-effect model, following adjustments for age and gender, revealed that the eGFR was significantly associated (P<0.0017) with serum levels of triglycerides, low-density lipoprotein cholesterol, uric acid, blood glycosylated hemoglobin content, fasting plasma glucose and body mass index. These parameters decreased curvilinearly with increases in eGFR. Furthermore, eGFR correlated positively with serum levels of high-density lipoprotein (HDL) cholesterol. Longitudinal analysis using the generalized estimating equation following adjustment for age and gender indicated a significant association (P<0.0024) between eGFR and prevalence of hypertension, type 2 diabetes mellitus, hypo-HDL cholesterolemia, hyperuricemia and obesity. Thus, low eGFR results in detrimental effects on various clinical parameters and conditions, resulting in increased risk of hypertension, dyslipidemia, type 2 diabetes mellitus, hyperuricemia and obesity.

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Glycated Hemoglobin and the Risk of Kidney Disease and Retinopathy in Adults With and Without Diabetes

Cited by 121 publications

References 35 publications

Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study

Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study

Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control

Association of renal function with clinical parameters and conditions in a longitudinal population-based epidemiological study

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