High levels of fasting glucose and glycosylated hemoglobin values are associated with hyperfiltration in a Spanish prediabetes cohort. The PREDAPS Study

Abstract

AimThis study aimed to investigate whether different levels of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) in prediabetes are associated with hyperfiltration.MethodsA prospective cohort of 2,022 individuals aged 30–74 years took part in the PREDAPS Study. One cohort of 1,184 participants with prediabetes and another cohort of 838 participants with normal FPG and normal HbA1c were followed for 5 years. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile for healthy control participants, while hypofiltration was defined as an eGFR below the 5th percentile. The prevalence of hyperfiltration was compared for different levels of prediabetes: level 1 of prediabetes: FPG <100 mg/dL plus HbA1c 5.7–6.0% or FPG 100–109 mg/dL plus HbA1c < 5.7%; level 2 of prediabetes: FPG <100 mg/dL plus HbA1c 6.1–6.4% or FPG 100–109 mg/dL plus HbA1c 5.7–6.0% or FPG 110–125 mg/dL plus HbA1c <5.7% and level 3 of prediabetes: FPG 100–109 mg/dL plus HbA1c 6.1–6.4% or FPG 110–125 mg/dL plus HbA1c 5.7–6.4%.ResultsThe participants with hyperfiltration were significantly younger, had a higher percentage of active smokers, and lower levels of hemoglobin and less use of ACEIs or ARBs.Only level 3 prediabetes based on FPG 100–109 mg/dL plus HbA1c 6.1–6.4% or FPG 110–125 mg/dL plus HbA1c 5.7–6.4% had a significantly higher odds ratio (OR) of hyperfiltration (OR 1.69 (1.05–2.74); P < 0.001) compared with no prediabetes (FPG < 100 mg/dL and HbA1c < 5.7%) after adjustment for different factors. The odds ratios for different levels of HbA1c alone in prediabetes increased progressively, but not significantly.ConclusionsLevel 3 of prediabetes based on FPG 100–109 mg/dL plus HbA1c 6.1–6.4% or FPG 110–125 mg/dL plus HbA1c 5.7–6.4% had a significantly higher OR of hyperfiltration compared with participants without prediabetes.

The Association Between the Decline of eGFR and a Reduction of Hemoglobin A1c in Type 2 Diabetic Patients

“…Due to hyperglycemia-related hyperfiltration, the measured GFR decreased from 149 to 129 ml/min per 1.73 m 2 (16% reduction) after HbA 1c dropped from 10% to 7% and increased significantly toward the baseline values along with HbA 1c control deterioration in patients with T1D ( 20 ). Additionally, HbA 1c was positively associated with eGFR, whether independently or together with fasting plasma glucose (FPG), in participants with prediabetes and was associated with significantly increased odds ratios (ORs) of hyperfiltration ( 21 , 22 ). It was reported that every 1% increase in HbA 1c levels and a 2.0 mmol/L increase in 2-h post-load glucose (2hPG) were associated with a 17% and 61.4% higher risk of hyperfiltration, respectively ( 23 , 24 ).…”

Association of estimated glomerular filtration rate and incident pre-diabetes: A secondary 5-year longitudinal cohort study in Chinese people

“…This would explain our findings that when eGFR is less than 130 ml/min/1.73m 2 , declining eGFR is associated with an increased risk of developing pre-diabetes in the future. However, it has also been shown that pre-diabetes is strongly related to glomerular hyperfiltration ( 17 , 47 – 49 ). Glomerular hyperfiltration has been associated with the early stages of nephropathy that evolved into CKD ( 50 ).…”

Addressing the Continuum of Dysglycaemia and Vascular Complications in Prediabetes and Type 2 Diabetes: Need for Early and Intensive Treatment

“…63 Similarly, prediabetes has been associated with dysfunction of the kidney. 30,62,[64][65][66][67][68][69][70][71][72] Evidence of neuropathy or microvascular dysfunction has been found in people with vs without prediabetes in skin, 56 the heart, 73,74 and in sensory nerves. 75 Other studies showed trends to adverse changes in nerve function, rather than overt neuropathy, in people with prediabetes.…”