HbA1C variability and the risk of renal status progression in Diabetes Mellitus: a meta-analysis

Dongsheng Cheng; Yang Fei; Yumei Liu; Junhui Li; Qin Xue; Xiaoxia Wang; Niansong Wang

doi:10.1371/journal.pone.0115509

HbA1C variability and the risk of renal status progression in Diabetes Mellitus: a meta-analysis

PLoS One. 2014 Dec 18;9(12):e115509. doi: 10.1371/journal.pone.0115509. eCollection 2014.

Authors

Dongsheng Cheng¹, Yang Fei¹, Yumei Liu¹, Junhui Li¹, Qin Xue¹, Xiaoxia Wang¹, Niansong Wang¹

Affiliation

¹ Department of Nephrology and Rheumatology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China, 200233.

Abstract

Objective: To explore the association between glycated hemoglobin (A1C) variability and renal disease progression in patients with diabetes mellitus.

Methods: A comprehensive search was performed using the PubMed and Embase databases (up to April 26, 2014). The hazard ratio (HR) was pooled per unit increase in the standard deviation of A1C (A1C-SD) to evaluate the dose-response relationship between A1C-SD and the risk of nephropathy.

Results: Eight studies with a total of 17,758 subjects provided the HR for A1C-SD and were included in the final meta-analysis. The pooled HR results demonstrated that A1C-SD was significantly associated with the progression of renal status (HR for both T1DM and T2DM 1.43, 95% confidence interval [CI] 1.24-1.64; HR for T1DM 1.70, 95%CI 1.41-2.05; HR for T2DM 1.20, 95%CI 1.12-1.28). A1C-SD was significantly correlated with new-onset microalbuminuria (HR for T1DM 1.63, 95%CI 1.28-2.07; HR for T2DM 1.23, 95%CI 1.08-1.39). These outcomes were also supported in subgroup analyses. Furthermore, sensitivity analyses demonstrated that the results were robust.

Conclusions: A1C variability is independently associated with the development of microalbuminuria and the progression of renal status in both type 1 and 2 diabetes patients. A standard method for measuring A1C variability is essential for further and deeper analyses. In addition, future studies should assess the effect of reducing A1C variability on nephropathy complication.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Diabetic Nephropathies / genetics*
Female
Genetic Heterogeneity*
Glycated Hemoglobin / genetics*
Humans
Male

Substances

Glycated Hemoglobin A
hemoglobin A1c protein, human

Grants and funding

This research is supported by grants from the Project of National Nature Science Foundation of China (81270824), Shanghai Science and Technology Project (11DZ1921904 and 11410708500). The funders played no role in the study design, data collection and analysis, decision to publish, and preparation of the manuscript.