Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Diabetologia. 2012 Dec;55(12):3163-72. doi: 10.1007/s00125-012-2700-4. Epub 2012 Aug 26.
AIMS/HYPOTHESIS: HbA(1c) variability has been shown to be an independent risk factor for nephropathy in patients with type 1 diabetes. In this study, we aimed to explore the association between HbA(1c) variability and microalbuminuria development in patients with type 2 diabetes. We also intended to test the applicability of serially measured HbA(1c) over 2 years for this risk assessment.
Between 2003 and 2005, we recruited 821 middle-aged normoalbuminuric individuals with type 2 diabetes and followed them through to the end of 2010. The average follow-up time was 6.2 years. We defined microalbuminuria as a urine albumin to creatinine ratio of 30 mg/g (3.4 mg/mmol) or higher. HbA(1c) variability was calculated by the SD of serially measured HbA(1c). The Cox proportional hazards model was used to evaluate the association between HbA(1c) SD quartile and development of microalbuminuria.
The incidence of microalbuminuria for the overall population was 58.4, 58.6, 60.8 and 91.9 per 1,000 person-years for Q1- to Q4-adjusted HbA(1c) SD, respectively (p for trend = 0.042). Compared with patients in Q1, those in Q4 were about 37% more likely to develop microalbuminuria. The HR derived from a series of 2 year HbA(1c) measurements was similar to that from data collection for longer than 4 years.
CONCLUSIONS/INTERPRETATION: In addition to mean HbA(1c) values, HbA(1c) variability, even measured as early as 2 years, is independently associated with the development of microalbuminuria in patients with type 2 diabetes.
目的/假设：糖化血红蛋白（HbA1c）变异性已被证明是 1 型糖尿病患者肾病的独立危险因素。在这项研究中，我们旨在探讨 2 型糖尿病患者 HbA1c 变异性与微量白蛋白尿发展之间的关系。我们还打算测试在 2 年内连续测量 HbA1c 对这种风险评估的适用性。
在 2003 年至 2005 年期间，我们招募了 821 名中年无白蛋白尿的 2 型糖尿病患者，并随访至 2010 年底。平均随访时间为 6.2 年。我们将微量白蛋白尿定义为尿白蛋白与肌酐比值为 30mg/g（3.4mg/mmol）或更高。HbA1c 变异性通过连续测量的 HbA1c 的标准差来计算。Cox 比例风险模型用于评估 HbA1c SD 四分位间距与微量白蛋白尿发展之间的关系。
对于整个人群，Q1 到 Q4 调整后的 HbA1c SD 的微量白蛋白尿发生率分别为每 1000 人年 58.4、58.6、60.8 和 91.9（趋势检验的 p 值为 0.042）。与 Q1 组相比，Q4 组发生微量白蛋白尿的风险约高 37%。从一系列 2 年 HbA1c 测量值中得出的 HR 与 4 年以上数据采集得出的 HR 相似。
结论/解释：除了平均 HbA1c 值外，HbA1c 变异性，甚至早在 2 年内测量，也与 2 型糖尿病患者微量白蛋白尿的发展独立相关。
