HbA1c variability is independently associated with progression of diabetic kidney disease in an urban multi-ethnic cohort of people with type 1 diabetes
Authors' conclusion
We observed an independent association between HbA1c variability, evaluated using three distinct methods, and significant kidney disease progression in a multi-ethnic type 1 diabetes cohort. Further studies are needed to elucidate the mechanisms that may explain our results and evaluate if HbA1c variability is a modifiable risk factor for preventing diabetic kidney disease progression.
Study context
- Population
- People with T1D and preserved eGFR ≥45 ml/min per 1.73 m² at baseline, attending outpatient clinics 2004–2018 at two London university hospitals, with ≥6 follow-up HbA1c measurements; 50% female, 78% White, 13% African Caribbean, 3% Asian, 6% mixed/other249 (7%) progressed
- Participants
- 3,466 people
- Exposure
- Highest vs lowest HbA1c variability quartile
- Outcome
- Kidney disease progression: eGFR decline of ≥50% from baseline with final eGFR <30 ml/min per 1.73 m²
- Follow-up
- Median (IQR) 8.2 (4.2-11.6) years
Methodological detailsmulti-ethnic, electronic health record data, two university hospitals, London
- Multi-ethnic
- Electronic health record data
- Two university hospitals, London
Main finding
As reported in the abstract
Kidney disease progression by HbA1c variability quartile
Highest HbA1c variability quartile vs Lowest HbA1c variability quartileHazard ratio (95% CI)
Method 1: SD-HbA1c; abstract labels quartiles 'lowestvs highest'; higher variability = higher risk
7.76(4.54–13.26)
Method 2: visit-adjusted SD (adj-HbA1c)
2.62(1.75–3.94)
Method 3: CV-HbA1c
5.46(3.40–8.79)
Observational data: associations, not effects.
Further findings
Kidney disease progression with African Caribbean ethnicity
- HR (95% CI), method 1
- 1.47 [1.09, 1.98]
- HR (95% CI), method 2
- 1.76 [1.32, 2.36]
- HR (95% CI), method 3
- 1.57 [1.17, 2.12]
- Independent of glycaemic variability and other traditional risk factors
Other risk factors for kidney disease progression
- Increasing age, baseline HbA1c, systolic BP and urinary albumin/creatinine ratio associated with progression
- P < 0.05 for all
Original publication
HbA1c variability is independently associated with progression of diabetic kidney disease in an urban multi-ethnic cohort of people with type 1 diabetes. Diabetologia. Published 20 June 2024. doi:10.
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