Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 9 (4), e96264

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


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

Petter Bjornstad et al. PLoS One.


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.


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.

Similar articles

See all similar articles

Cited by 9 articles

See all "Cited by" articles


    1. Maahs DM, Rewers M (2006) Editorial: Mortality and renal disease in type 1 diabetes mellitus—progress made, more to be done. J Clin Endocrinol Metab 91: 3757–3759. - PubMed
    1. Orchard TJ, Secrest AM, Miller RG, Costacou T (2010) In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetologia 53: 2312–2319. - PMC - PubMed
    1. American Diabetes Association (2013) Standards of medical care in diabetes—2013. Diabetes Care 36 Suppl 1 S11–66. - PMC - PubMed
    1. National Kidney Foundation (2007) KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis 49: S12–154. - PubMed
    1. Stevens PE, Levin A (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158: 825–830. - PubMed

Publication types