Lee Da Young, Kim Jaeyoung, Park Sanghyun, Park So Young, Yu Ji Hee, Seo Ji A, Kim Nam Hoon, Yoo Hye Jin, Kim Sin Gon, Choi Kyung Mook, Baik Sei Hyun, Han Kyungdo, Kim Nan Hee
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea.
Research Institute for Skin Image, Korea University College of Medicine, Seoul 08308, Korea.
J Clin Med. 2021 Dec 18;10(24):5948. doi: 10.3390/jcm10245948.
Given the fact that diabetes remains a leading cause of end-stage kidney disease (ESKD), multi-aspect approaches anticipating the risk for ESKD and timely correction are crucial. We investigated whether fasting glucose variability (FGV) could anticipate the development of ESKD and identify the population prone to the harmful effects of GV. We included 777,192 Koreans with diabetes who had undergone health examinations more than three times in 2005-2010. We evaluated the risk of the first diagnosis of ESKD until 2017, according to the quartile of variability independent of the mean (VIM) of FG using multivariate-adjusted Cox proportional hazards analyses. During the 8-year follow-up, a total of 7290 incidents of ESKD were found. Subjects in the FG VIM quartile 4 had a 27% higher risk for ESKD compared to quartile 1, with adjustment for cardiovascular risk factors and the characteristics of diabetes. This effect was more distinct in patients aged < 65 years; those with a long duration of diabetes; the presence of hypertension or dyslipidemia; and prescribed angiotensin-converting enzyme inhibitors, metformin, sulfonylurea, α-glucosidase inhibitors, and insulin. In contrast, the relationship between baseline FG status and ESKD risk showed a U-shaped association. FGV is an independent risk factor for kidney failure regardless of FG.
鉴于糖尿病仍然是终末期肾病（ESKD）的主要病因，采用多方面方法预测ESKD风险并及时纠正至关重要。我们调查了空腹血糖变异性（FGV）是否能够预测ESKD的发生，并确定易受血糖变异性有害影响的人群。我们纳入了2005年至2010年间接受过三次以上健康检查的777192名韩国糖尿病患者。我们使用多变量调整的Cox比例风险分析，根据独立于空腹血糖均值（VIM）的变异性四分位数，评估了截至2017年首次诊断为ESKD的风险。在8年的随访期间，共发现7290例ESKD事件。在调整心血管危险因素和糖尿病特征后，空腹血糖VIM四分位数4的受试者发生ESKD的风险比四分位数1高27%。这种效应在年龄<65岁的患者、糖尿病病程长的患者、患有高血压或血脂异常的患者以及使用血管紧张素转换酶抑制剂、二甲双胍、磺脲类、α-葡萄糖苷酶抑制剂和胰岛素的患者中更为明显。相比之下，基线空腹血糖状态与ESKD风险之间的关系呈U形关联。无论空腹血糖如何，FGV都是肾衰竭的独立危险因素。
