Poor glycaemic control tied to faster kidney function decline after DKD onset

Poor glycaemic control in patients with type 1 (T1D) or type 2 diabetes (T2D) contributes to a faster estimated glomerular filtration rate (eGFR) decline following diabetic kidney disease (DKD) onset, suggests a study. This association is more pronounced among those with severe albuminuria.

A total of 530 patients with T1D and early-to-moderate DKD from the Preventing Early Renal Loss (PERL) trial and 2,378 individuals with T2D and established DKD from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial were included in this analysis.

The authors examined the association between baseline glycated haemoglobin (HbA1c) and rates of eGFR loss during follow-up using mixed-effects linear regression.

A higher baseline HbA1c correlated with eGFR decline in both PERL (‒0.87 mL/min/1.73 m²/year per Hba1c unit increment; p<0.0001) and ACCORD (‒0.27 mL/min/1.73 m²/year per Hba1c unit increment; p=0.0002) studies. This association progressively grew with increasing levels of albuminuria (p<0.05 for interaction) in both studies.

Moreover, the benefit of intensive glycaemic control on eGFR decline was greater among ACCORD patients who had severe albuminuria than those with moderate albuminuria (1.13 vs 0.26 mL/min/1.73 m²/year; p=0.01). In PERL, independent associations were not observed between short-term glycaemic variability indices and rate of eGFR decline.

“In both T1D and T2D, poor glycaemic control is associated with a more rapid rate of GFR decline after DKD onset, especially in persons with severe albuminuria,” the authors said.