Journal
PLOS ONE
Volume 10, Issue 6, Pages -Publisher
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0130828
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Funding
- Bureau of National Health Insurance [DOH94-NH-1007]
- Ministry of Science and Technology of Taiwan (National Science Council) [NSC101-2314-B-039-017-MY3, NSC102-2314-B-039-005-MY2]
- China Medical University [CMU103-S-10]
- Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence [MOHW103-TDU-B-212-113002]
- Ministry of Health and Welfare [DOH101-HP-1102, DOH102-HP-1102, MOHW103-HPA-H-114-133105]
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Background Whether HbA1c is a predictor of end-stage renal disease (ESRD) in type 2 diabetes patients remains unclear. This study evaluated relationship between HbA1c and ESRD in Chinese patients with type 2 diabetes. Methods Patients aged >= 30 years who were free of ESRD (n = 51 681) were included from National Diabetes Care Management Program from 2002-2003. Extended Cox proportional hazard model with competing risk of death served to evaluate association between HbA1c level and ESRD. Results A total of 2613 (5.06%) people developed ESRD during a follow-up period of 8.1 years. Overall incidence rate of ESRD was 6.26 per 1000 person-years. Patients with high levels of HbA1c had a high incidence rate of ESRD, from 4.29 for HbA1c of 6.0%-6.9% to 10.33 for HbA1c >= 10.0% per 1000 person-years. Patients with HbA1c < 6.0% particularly had a slightly higher ESRD incidence (4.34 per 1000 person-years) than those with HbA1c of 6.0%-6.9%. A J-shaped relationship between HbA1c level and ESRD risk was observed. After adjustment, patients with HbA1c < 6.0% and >= 10.0% exhibited an increased risk of ESRD (HR: 1.99, 95% CI: 1.62-2.44; HR: 4.42, 95% CI: 3.80-5.14, respectively) compared with those with HbA1c of 6.0%-6.9%. Conclusions Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia. Our study revealed that HbA1c level >= 7.0% was linked with increased ESRD risk in type 2 diabetes patients, and that HbA1c < 6.0% also had the potential to increase ESRD risk. Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population. Clinicians need to pay attention to HbA1c results on diabetic nephropathy.
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