Poor Glycemic Control Is Associated With More Rapid Kidney Function Decline After the Onset of Diabetic Kidney Disease
Authors' conclusion
In both type 1 and type 2 diabetes, poor glycemic control is associated with a more rapid rate of glomerular filtration rate decline after DKD onset, especially in persons with severe albuminuria.
Study context
- Population
- Individuals with T1D and early-to-moderate diabetic kidney disease (DKD) (PERL trial) and T2D with established DKD (ACCORD trial)
- Participants
- 530 vs 2,378
- Comparison
- Baseline HbA1c and estimated glomerular filtration rate (eGFR) slope; intensive vs standard glycaemic control
- PERLn = 530
- ACCORDn = 2,378
- Primary endpoint
- Association of baseline HbA1c with rate of eGFR loss during follow-up
Methodological detailsmixed-effects linear regression
- Mixed-effects linear regression
Primary result
As reported in the abstract
eGFR slope per HbA1c unit increment
| Group | Value | P |
|---|---|---|
| PERL | −0.87 mL/min/1.73 m²/year per Hba1c unit increment | P < .0001 |
| ACCORD | −0.27 mL/min/1.73 m²/year per Hba1c unit increment | P = .0002 |
Value
PERL−0.87 mL/min/1.73 m²/year per Hba1c unit increment
ACCORD−0.27 mL/min/1.73 m²/year per Hba1c unit increment
P
PERLP < .0001
ACCORDP = .0002
Further findings
| Outcome | P value |
|---|---|
| Benefit of intensive glycaemic control on eGFR decline (ACCORD), by albuminuriaSevere albuminuria vs Moderate albuminuria · +1.13 vs + 0.26; greater with severe albuminuria | P = 0.01 |
Effect modification by albuminuria
- Strength of association progressively increased with increasing albuminuria in both studies
- P for interaction < 0.05
CGM-derived short-term glycaemic variability and eGFR decline (PERL)
- No independent associations found
Original publication
Poor Glycemic Control Is Associated With More Rapid Kidney Function Decline After the Onset of Diabetic Kidney Disease. J Clin Endocrinol Metab. Published 23 January 2024. doi:10.
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