Clinical Research Unit, Khoo Teck Puat Hospital, Yishun, Singapore.
Department of Medicine, Sengkang General Hospital, Singapore, Singapore.
Nephrology (Carlton). 2019 Oct;24(10):1026-1032. doi: 10.1111/nep.13533. Epub 2019 May 2.
To characterize haemoglobin A1c (HbA1c) trajectories and examine their associations with chronic kidney disease (CKD) progression.
This was a prospective cohort study on 770 patients with type 2 diabetes mellitus (T2DM) attending a diabetes centre in 2002-2017. Group-based trajectory modelling was used to identify HbA1c trajectories. Cox proportional hazards models were used to examine association between the trajectories and CKD progression which was defined as deterioration across the Kidney Disease: Improving Global Outcomes estimated glomerular filtration rate categories with ≥25% drop from baseline.
We identified four HbA1c trajectories: 'near-optimal stable' (49.1%), 'moderate stable' (37.9%), 'moderate-increasing' (6.0%) and 'high-decreasing' (7.0%). Over a median follow-up period of 4.6 years (interquartile range 2.5-5.6), CKD progression occurred in 35.6% of patients. The risk of CKD progression was significantly higher in the moderate-increasing with adjusted hazard ratios (HR) 2.23 (95% confidence interval (CI) 1.09-4.57). After additional adjustment for mean HbA1c, the association between the moderate-increasing subgroup and CKD progression remained significant at HR 3.07 (95% CI 1.08-8.77).
Moderate-increasing HbA1c trajectory is associated with renal disease progression in patients with T2DM, independent of mean HbA1c. The deleterious effects of deteriorating HbA1c trajectory highlight the importance of achieving sustained good glycaemic control in diabetes management.
描述糖化血红蛋白（HbA1c）轨迹，并探讨其与慢性肾脏病（CKD）进展的关系。
这是一项对 2002 年至 2017 年在一家糖尿病中心就诊的 770 例 2 型糖尿病（T2DM）患者进行的前瞻性队列研究。采用基于群组的轨迹模型识别 HbA1c 轨迹。Cox 比例风险模型用于检验轨迹与 CKD 进展的关系，CKD 进展定义为通过改善全球肾脏病结局组织估算肾小球滤过率（eGFR）分类，从基线下降≥25%。
我们确定了四种 HbA1c 轨迹：“接近最佳稳定”（49.1%）、“中度稳定”（37.9%）、“中度升高”（6.0%）和“高降低”（7.0%）。在中位随访时间为 4.6 年（四分位距 2.5-5.6）期间，35.6%的患者发生 CKD 进展。中度升高轨迹的 CKD 进展风险明显更高，调整后的危险比（HR）为 2.23（95%置信区间[CI]为 1.09-4.57）。在进一步调整平均 HbA1c 后，中度升高亚组与 CKD 进展之间的相关性仍具有统计学意义，HR 为 3.07（95%CI 为 1.08-8.77）。
在 T2DM 患者中，HbA1c 中度升高轨迹与肾脏疾病进展相关，独立于平均 HbA1c。HbA1c 轨迹恶化的不良影响突显了在糖尿病管理中实现持续良好血糖控制的重要性。
