Park Su Bin, Kim Sang Soo, Kim In Joo, Nam Yoon Jeong, Ahn Kang Hee, Kim Jong Ho, Jeon Yun Kyung, Kim Bo Hyun, Song Sang Heon, Kwak Ihm Soo, Lee Eun Kyung, Kim Yong Ki
Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
J Diabetes Complications. 2017 Jun;31(6):1041-1046. doi: 10.1016/j.jdiacomp.2017.01.014. Epub 2017 Feb 3.
The present study was performed to assess variability in glycated albumin (GA) using a coefficient of variation (CV) to predict the progression of diabetic nephropathy in type 2 diabetic patients, independently of HbA1c and other conventional risk factors.
The present study consecutively enrolled 369 patients with type 2 diabetes mellitus from outpatient clinic. During the follow-up period, GA and HbA1c levels were measured repeatedly (≥5 times), and the CV of GA (GA-CV) was calculated for each patient. The patients were divided into two subgroups: Group 1, a MEAN-HbA1c value <7.2% (55mmol/mol); Group 2, a MEAN-HbA1c value ≥7.2% (55mmol/mol). The primary outcome was the renal composite outcome (RCO), which was based on the progression rates of chronic kidney disease and albuminuria and renal death.
The median follow-up period was 33months. The RCO was developed in 109 patients (29.5%). In Group 1, the third highest and highest quartile groups for GA-CV had higher cumulative incidences of the RCO than those of the lowest quartile group (Q4 vs. Q1: HR=5.43, P=0.007, Q3 vs. Q1: HR=5.16, P=0.009). After adjusting for HbA1c levels and other risk factors, the GA-CV remained significantly associated with the development of the RCO. However, Group 2 did not exhibit any significant differences in terms of the cumulative incidence of the RCO among the four GA-CV quartile groups.
The present findings suggest that variability in GA may be a better predictor of the progression of diabetic nephropathy in type 2 diabetic patients regardless of HbA1c.
本研究旨在使用变异系数（CV）评估糖化白蛋白（GA）的变异性，以预测2型糖尿病患者糖尿病肾病的进展，独立于糖化血红蛋白（HbA1c）和其他传统风险因素。
本研究连续纳入了369例门诊2型糖尿病患者。在随访期间，重复测量GA和HbA1c水平（≥5次），并计算每位患者的GA变异系数（GA-CV）。患者被分为两个亚组：第1组，平均HbA1c值<7.2%（55mmol/mol）；第2组，平均HbA1c值≥7.2%（55mmol/mol）。主要结局是肾脏复合结局（RCO），其基于慢性肾脏病、蛋白尿和肾脏死亡的进展率。
中位随访期为33个月。109例患者（29.5%）出现了RCO。在第1组中，GA-CV的第三高和最高四分位数组的RCO累积发生率高于最低四分位数组（Q4 vs. Q1：HR=5.43，P=0.007，Q3 vs. Q1：HR=5.16，P=0.009）。在调整HbA1c水平和其他风险因素后，GA-CV仍与RCO的发生显著相关。然而，在第2组中，四个GA-CV四分位数组之间的RCO累积发生率没有显著差异。
本研究结果表明，无论HbA1c如何，GA的变异性可能是2型糖尿病患者糖尿病肾病进展的更好预测指标。
