HbA1c variability as an independent correlate of nephropathy, but not retinopathy, in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study.
HbA1c variability as an independent correlate of nephropathy, but not retinopathy, in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study.
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DOI：
10.2337/dc12-2264
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发表时间：
2013-08
期刊：
影响因子：
16.2
通讯作者：
Renal Insufficiency And Cardiovascular Events Study Group
中科院分区：
文献类型：
--
作者：
Penno G;Solini A;Bonora E;Fondelli C;Orsi E;Zerbini G;Morano S;Cavalot F;Lamacchia O;Laviola L;Nicolucci A;Pugliese G;Renal Insufficiency And Cardiovascular Events Study Group
在来自意大利多中心研究的肾功能不全和心血管事件（RIACE）的2型糖尿病受试者大型队列中，检查血红蛋白（Hb）A1 c变异性与微血管并发症的相关性。从9家中心的8，260例受试者（19家中心的15，773例患者）中获得了入组前2年期间收集的系列（3-5）HbA 1c值。HbA 1c变异性测量为4.52 ± 0.76值的个体内SD。通过散瞳眼底镜检查评估糖尿病视网膜病变（DR）。慢性肾脏疾病（CKD）的定义基于免疫比浊法或免疫比浊法测定的白蛋白尿，估计肾小球滤过率（eGFR）由血清肌酐计算。平均HbA 1c（HbA 1c-MEAN）和HbA 1c-SD的中位数和四分位距分别为7.57%（6.86-8.38）和0.46%（0.29-0.74）。当两个HbA 1c参数均高于中位数时，观察到微量白蛋白尿、大量白蛋白尿、eGFR降低、白蛋白尿CKD表型和晚期DR的患病率最高，当两个参数均低于中位数时，患病率最低。Logistic回归分析显示，HbA 1c-SD与HbA 1c-MEAN相加，是微量白蛋白尿和1-2期CKD的独立相关因素，是大量白蛋白尿、eGFR降低和3-5期白蛋白尿CKD的独立预测因子，而HbA 1c-MEAN不是。DR的情况正好相反，而HbA 1c-MEAN和HbA 1c-SD均不影响非白蛋白尿性CKD。在2型糖尿病患者中，HbA 1c变异性对（白蛋白尿）CKD的影响大于平均HbA 1c，而仅后者参数影响DR，因此表明这些措施对微血管并发症的可变影响。
To examine the association of hemoglobin (Hb) A1c variability with microvascular complications in the large cohort of subjects with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. Serial (3–5) HbA1c values collected in a 2-year period before enrollment were available from 8,260 subjects from 9 centers (of 15,773 patients from 19 centers). HbA1c variability was measured as the intraindividual SD of 4.52 ± 0.76 values. Diabetic retinopathy (DR) was assessed by dilated funduscopy. Chronic kidney disease (CKD) was defined based on albuminuria, as measured by immunonephelometry or immunoturbidimetry, and estimated glomerular filtration rate (eGFR) was calculated from serum creatinine. Median and interquartile range of average HbA1c (HbA1c-MEAN) and HbA1c-SD were 7.57% (6.86–8.38) and 0.46% (0.29–0.74), respectively. The highest prevalence of microalbuminuria, macroalbuminuria, reduced eGFR, albuminuric CKD phenotypes, and advanced DR was observed when both HbA1c parameters were above the median and the lowest when both were below the median. Logistic regression analyses showed that HbA1c-SD adds to HbA1c-MEAN as an independent correlate of microalbuminuria and stages 1–2 CKD and is an independent predictor of macroalbuminuria, reduced eGFR, and stages 3–5 albuminuric CKD, whereas HbA1c-MEAN is not. The opposite was found for DR, whereas neither HbA1c-MEAN nor HbA1c-SD affected nonalbuminuric CKD. In patients with type 2 diabetes, HbA1c variability affects (albuminuric) CKD more than average HbA1c, whereas only the latter parameter affects DR, thus suggesting a variable effect of these measures on microvascular complications.
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影响因子：
5.3
作者：
Pugliese, Giuseppe;Solini, Anna;Penno, Giuseppe
通讯作者：
Penno, Giuseppe
影响因子：
16.2
作者：
Kilpatrick, Eric S.;Rigby, Alan S.;Atkin, Stephen L.
通讯作者：
Atkin, Stephen L.
影响因子：
16.2
作者：
Thomas MC;Macisaac RJ;Jerums G;Weekes A;Moran J;Shaw JE;Atkins RC
通讯作者：
Atkins RC
影响因子：
105.7
作者：
Stratton, IM;Adler, AI;Holman, RR
通讯作者：
Holman, RR
影响因子：
16.2
作者：
Solini A;Penno G;Bonora E;Fondelli C;Orsi E;Arosio M;Trevisan R;Vedovato M;Cignarelli M;Andreozzi F;Nicolucci A;Pugliese G;Renal Insufficiency And Cardiovascular Events (RIACE) Study Group
通讯作者：
Renal Insufficiency And Cardiovascular Events (RIACE) Study Group