Hailu Habte-Asres, Hellena; Murrells, Trevor; Nitsch, Dorothea; Wheeler, David C; Forbes, Angus; (2022) Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: Retrospective cohort study. Diabetes Research and Clinical Practice , 193 , Article 110117. 10.1016/j.diabres.2022.110117.

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Abstract

AIM: To investigate the association between glycaemic variability and the development of End-Stage-Kidney-Disease (ESKD) among individuals with diabetes and chronic kidney disease. METHODS: A cohort study using UK electronic primary care health records from the Clinical Practice Research Datalink. Glycaemic variability was assessed using a variability score and intra-individual coefficient of variation (CV) of HbA1c. We calculated sub-distribution hazard ratios (sHR) for developing ESKD using competing risk regression analysis. RESULTS: There were 37,222 eligible participants (45.5 % male), with a mean age of 76.4 years (SD±9.2), and a mean baseline eGFR 40.7 (± 10.7) ml/min/1.73m2. There were 5,086 incidents of ESKD in the follow-up period. The adjusted sHR (95%CI) for each variability score group, were as follows: 21-40, 1.38 (1.27 -1.50); 41-60, 1.54 (1.41- 1.68); 61-80, 1.61 (1.45 - 1.79); and 81-100, 1.42 (1.19 - 1.68), compared with the group (score 0-20) with least variability. The adjusted sHR for CV were as follows: 6.7 - 9.9, 1.29 (1.15 -1.45); 10.0 - 13.9, 1.55 (1.39- 1.74); 14.0 - 20.1, 1.79 (1.60 -2.01) and ≥ 20.2, 2.10 (1.88 - 2.34) compared to reference group 0 - 6.6. CONCLUSIONS: Glycaemic variability was strongly associated with the development of ESKD in people with diabetes and CKD.

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