Variability in estimated glomerular filtration rate and the incidence of type 2 diabetes: A nationwide population-based study

You Bin Lee, Da Hye Kim, Eun Roh, So Hyeon Hong, Jung A. Kim, Hye Jin Yoo, Sei Hyun Baik, Kyungdo Han, Kyung Mook Choi

Research output: Contribution to journalArticle

Abstract

Objective: Variability in estimated glomerular filtration rate (eGFR) has been associated with adverse outcomes in patients with diabetes or chronic kidney disease (CKD). However, no previous study has explored the relationship between eGFR variability and type 2 diabetes incidence. Research design and methods: In this nationwide, longitudinal, cohort study, we investigated the association between eGFR variability and type 2 diabetes risk using the Korean National Health Insurance Service datasets from 2002 to 2017. eGFR variability was calculated using the variability independent of the mean (eGFR-VIM), coefficient of variation (eGFR-CV), standard deviation (eGFR-SD) and average real variability (eGFR-ARV). Results: Within 7 673 905.58 person-years of follow-up (mean follow-up: 3.19 years; n=2 402 668), 11 981 cases of incident type 2 diabetes were reported. The HRs and 95% CIs for incident type 2 diabetes increased according to advance in quartiles of eGFR-VIM (HR (95% CI): Q2, 1.068 (1.009 to 1.130); Q3, 1.077 (1.018 to 1.138); Q4, 1.203 (1.139 to 1.270)) even after adjusting for confounding factors including mean eGFR and mean fasting plasma glucose levels. The subgroup analyses according to risk factors as well as analyses using eGFR-CV, eGFR-SD and eGFR-ARV showed consistent results. The association between increased eGFR variability and type 2 diabetes risk was more prominent in men, individuals with dyslipidemia and those with CKD as shown in the subgroup analysis (p for interaction <0.001). Conclusions: Increased eGFR variability may be an independent predictor of type 2 diabetes and might be useful for risk stratification of individuals without diabetes.

Original languageEnglish
Article numbere001187
JournalBMJ Open Diabetes Research and Care
Volume8
Issue number1
DOIs
Publication statusPublished - 2020 Apr 20

Keywords

  • GFR
  • chronic kidney disease
  • type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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    Lee, Y. B., Kim, D. H., Roh, E., Hong, S. H., Kim, J. A., Yoo, H. J., Baik, S. H., Han, K., & Choi, K. M. (2020). Variability in estimated glomerular filtration rate and the incidence of type 2 diabetes: A nationwide population-based study. BMJ Open Diabetes Research and Care, 8(1), [e001187]. https://doi.org/10.1136/bmjdrc-2020-001187