Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: An updated systematic review and meta-analysis

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2024-09-04 DOI:10.1111/dom.15861

Shihan Wang MM, Shuoning Song MD, Junxiang Gao MM, Yanbei Duo MD, Yuting Gao MD, Yong Fu MD, Yingyue Dong MBB, Tao Yuan MD, Weigang Zhao MD

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引用次数: 0

Abstract

Objective

To assess the association between glycated haemoglobin (HbA1c) variability and risk of renal function decline in type 2 diabetes mellitus (T2DM).

Research Design and Methods

A comprehensive search was carried out in PubMed, Embase, Web of Science and the Cochrane Library (until 12 March 2024). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines were followed for this meta-analysis. HbA1c variability was presented as indices of the standard deviation (SD), coefficient of variation (CV), HbA1c variability score (HVS) and haemoglobin glycation index (HGI). This meta-analysis was performed using random-effect models.

Results

Eighteen studies met the objectives of this meta-analysis. The analyses showed positive associations between HbA1c variability and kidney function decline, with hazard ratio (HR) 1.26 (95% confidence interval [CI] 1.15–1.38) for high versus low SD groups, HR 1.47 (95% CI 1.30–1.65) for CV groups, HR 1.32 (95% CI 1.10–1.57) for HVS groups and HR 1.53 (95% CI 1.05–2.23) for HGI groups. In addition, each 1% increase in SD and CV was linked to kidney function decline, with HR 1.26 (95% CI 1.17–1.35), and 1.13 (95% CI 1.03–1.23), respectively. Also, each 1-SD increase in SD of HbA1c was associated with deterioration in renal function, with HR 1.17 (95% CI 1.07–1.29).

Conclusions

The four HbA1c variability indicators were all positively associated with renal function decline progression; therefore, HbA1c variability might play an important and promising role in guiding glycaemic control targets and predicting kidney function decline progression in T2DM.

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糖化血红蛋白变异性与 2 型糖尿病肾功能衰退的风险：最新系统综述和荟萃分析。

研究目的评估糖化血红蛋白（HbA1c）变异性与 2 型糖尿病（T2DM）肾功能衰退风险之间的关联：在 PubMed、Embase、Web of Science 和 Cochrane 图书馆（截至 2024 年 3 月 12 日）进行了全面检索。荟萃分析遵循了系统综述和荟萃分析首选报告项目（PRISMA）声明指南。HbA1c 变异性以标准差 (SD)、变异系数 (CV)、HbA1c 变异性评分 (HVS) 和血红蛋白糖化指数 (HGI) 等指数表示。这项荟萃分析采用随机效应模型进行：结果：18 项研究符合本次荟萃分析的目标。分析结果显示，HbA1c 变异与肾功能下降之间存在正相关，高 SD 组与低 SD 组的危险比 (HR) 为 1.26（95% 置信区间 [CI] 1.15-1.38），CV 组的危险比为 1.47（95% CI 1.30-1.65），HVS 组的危险比为 1.32（95% CI 1.10-1.57），HGI 组的危险比为 1.53（95% CI 1.05-2.23）。此外，SD 和 CV 每增加 1%，肾功能就会下降，HR 分别为 1.26（95% CI 1.17-1.35）和 1.13（95% CI 1.03-1.23）。此外，HbA1c 的 SD 值每增加 1-SD 与肾功能恶化相关，HR 值为 1.17（95% CI 1.07-1.29）：结论：四项 HbA1c 变异性指标均与肾功能衰退进展呈正相关；因此，HbA1c 变异性可能在指导 T2DM 患者的血糖控制目标和预测肾功能衰退进展方面发挥重要而有前景的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.