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Mitra Kazemi Jahromi

Hormozgan University of Medical Sciences, Iran

Title: The association between Glycated Hemoglobin and glomerular filtration rate in type2 diabetic patients

Biography

Biography: Mitra Kazemi Jahromi

Abstract

Introduction: Diabetic nephropathy is a major cause of ESRD. Research has demonstrated that blood glucose control delays microalbuminuria, but there is controversy on its effect on GFR reduction. This study examines the relationship between HbA1C and GFR in T2DM patients.

Methods: The relationships between two levels of HbA1C (≤8% and >8%) and two levels of GFR (≤60% and >60%) were separately examined in 802 T2DM patients. GFR was calculated using the MDRD and EPI. Considering the possible role of anemia in HbA1C interpretation, both the male and female patients were divided into groups with (men: 7<Hb<9, 9<Hb<13; women: 7<Hb<9, 9<Hb<12) and without (men: Hb≥13; women: Hb≥12) anemia. The relationship between HbA1C and GFR was evaluated overall and also separately by HbA1C and GFR (<60 and ≥60).

Results: A total of 74.5% of those with HbA1C≤8% and 71% of those with HbA1C>8% were female. GFR was measured using both EPI and MDRD and correlated significantly with HbA1C>8% (P=0.019, P=0.006). No significant relationship existed between GFR and HbA1C in the classification of GFR (≤60 and >60). A significant inverse relationship existed in the classification based on anemia level between GFR<60 and HbA1C>8% in women. This relationship was observed in those without anemia (HbA1C>12) using both EPI and MDRD (P=0.007, P=0.004). No significant relationship existed for the other hemoglobin levels and in the cases with HbA1C≤8%. No significant relationship existed between different GFRs and HbA1C in men.

Conclusion: In T2DM patients without anemia (Hb>12), a significant inverse relationship exists between HbA1C>8% and GFR≤60 (with both MDRD and EPI), i.e. GFR dropped significantly as HbA1C increased. This relationship was significant only in women, which constituted the majority of the study population. No significant relationship was observed at Hb<12, which could confirm the role of anemia as a confounding variable in the interpretation of HbA1C.