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, 9 (4), e96264
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Fasting Blood Glucose--A Missing Variable for GFR-estimation in Type 1 Diabetes?

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Fasting Blood Glucose--A Missing Variable for GFR-estimation in Type 1 Diabetes?

Petter Bjornstad et al. PLoS One.

Abstract

Objective: Estimation of glomerular filtration rate (eGFR) is one of the current clinical methods for identifying risk for diabetic nephropathy in subjects with type 1 diabetes (T1D). Hyperglycemia is known to influence GFR in T1D and variability in blood glucose at the time of eGFR measurement could introduce bias in eGFR. We hypothesized that simultaneously measured blood glucose would influence eGFR in adults with T1D.

Methods: Longitudinal multivariable mixed-models were employed to investigate the relationships between blood glucose and eGFR by CKD-EPI eGFRCYSTATIN C over 6-years in the Coronary Artery Calcification in Type 1 diabetes (CACTI) study. All subjects with T1D and complete data including blood glucose and cystatin C for at least one of the three visits (n = 616, 554, and 521, respectively) were included in the longitudinal analyses.

Results: In mixed-models adjusting for sex, HbA1c, ACEi/ARB, protein and sodium intake positive associations were observed between simultaneous blood glucose and eGFRCYSTATIN C (β±SE:0.14±0.04 per 10 mg/dL of blood glucose, p<0.0001), and hyperfiltration as a dichotomous outcome (OR: 1.04, 95% CI: 1.01-1.07 per 10 mg/dL of blood glucose, p = 0.02).

Conclusions: In our longitudinal data in subjects with T1D, simultaneous blood glucose has an independent positive effect on eGFRCYSTATIN C. The associations between blood glucose and eGFRCYSTATIN C may bias the accurate detection of early diabetic nephropathy, especially in people with longitudinal variability in blood glucose.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Scatter plot of eGFR vs. spot glucose with fitted values from linear mixed model for the overall population.
Figure 2
Figure 2. Odds of Hyperfiltration eGFR > 120 mL/min/1.73 m2 by Cystatin C for a 10-unit increase in glucose (mg/dL) in multivariable models adjusted for gender, HbA1c, protein inake, sodium intake and ACEi/ARB use for for the overall population and stratified by ACEi/ARB use and gender.

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