Decrease of Hemoglobin A1c (HbA1c) in Patients with Type 2 Diabetes, Suboptimal Glycemic Control, in Advanced CKD, and Major Adverse Kidney Events

Le résumé fourni par la source

Background: In subjects with type 2 diabetes (DM), poor glycemic control, and advanced chronic kidney disease (CKD), the kidney benefit of the reduction of glycated hemoglobin (HbA1c) is not well established. Methods: In a retrospective cohort, we included patients with DM, CKD grade 3b-5, and HbA1c >9%, to evaluate the risk of developing major adverse kidney events (MAKE) defined as the start of kidney replacement therapy (KRT), ≥ 25% or ≥ 40% decline in the glomerular filtration rate (eGFR) from baseline, and death; according to the HbA1c groups at the end of the follow-up, divided by >75 mmol/mol (≥9.0%), 74-64 mmol/mol (8.9-8.0%), 64-53 mmol/mol (7.9-7.0%) and <52 mmol/mol (<7.0%). We described their characteristics and analyzed their risks adjusting for confounding variables. Results: During 2015 to 2023, 111 patients were included. In 46 (41.4%) the HbA1c at the end of follow-up (60 months) was still >75 mmol/mol (≥9%), each patient had a mean of 4.9 HbA1c measurements. The mean age was 59 years and 46% were male, baseline eGFR was 25 ml/min/1.73m2. MAKE occurred in 67% of cases. In a multivariate analysis, the risk of MAKE was not associated with the HbA1c groups. Nor was it associated with any of the MAKE components individually, nor in certain subgroups. When evaluating the magnitude of percentage changes in HbA1 with the initiation of KRT, we did not find any association. Conclusion: With advanced CKD and poor glycemic control, changes in HbA1c during long follow-up are not associated with MAKE or its individual components.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.