ESRD risk in diabetes not influenced by HbA1c: New study
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Higher levels of HbA1c do not increase the composite risk for end-stage kidney disease and death in adults with diabetes, according to findings published in the Journal of Diabetes and its Complications.

“Intensive glucose-lowering therapy is proven to reduce the risk of developing [diabetic kidney disease]. However, the effects of intensive glucose-lowering therapy on progression of existing [diabetic kidney disease] are unclear,” the authors write. In addition, these agents pose their own risks to patients with diabetes, the researchers wrote in the study background.

A total of 618 participants (mean age, 60 years;308 with diabetes) from the study were included for analysis.
The primary outcome was the composite of end-stage kidney disease and death, which were both determined based on data from the National Death Index and the United States Renal Data System. End-stage kidney disease was confirmed when a participant began maintenance dialysis or had a kidney transplant.

In the study population, there were 343 instances of composite end-stage kidney disease and death, but higher HbA1c levels were not linked to these events in participants with diabetes. Researchers observed a nonstatistically significant 1% lower risk of composite outcome per 1% higher level of HbA1c.

“A more customized approach to target HbA1c levels might be necessary to prevent the adverse effects of overtreatment in these patients. Long-term diabetes may cause autonomic dysfunction and ‘hypoglycemic unawareness,’ and ‘self -monitoring glucose’ should be emphasized and routinely done in diabetic CKD to prevent subclinical hypoglycemic episodes,” the researchers wrote.

“Finally, these data suggest that glycemic control alone may be insufficient to account for the progression of diabetic complications, especially in diabetic CKD patients.”

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